Asystole

Introduction

Asystole generally occurs as a terminal rhythm in a patient with severe underlying cardiac disease. Likelihood of resuscitation is low. ALGORITHM FOR TREATMENT OF ASYSTOLE CPR until defibrillator is available Confirm asystole in more than one lead If rhythm is unclear, possibly VF, defibrillation If asystole is confirmed, continue CPR Intubate, Establish IV access (IV/ IO access takes precedence) Consider possible causes & initiate appropriate treatment hypoxia, hyperkalemia, hypokalemia, pre-existing acidosis drug overdose, hypothermia Consider immediate transcutaneous pacing [1] Epinephrine*, 1 mg IV push, repeat every 3-5 minutes * Vasopressin 40 IU IV may be better than epinephrine [2] Atropine 1 mg IV push, repeat every 3-5 minutes up to 3 mg If no response, consider: high dose epinephrine [2], NaHCO3 if appropriate [3], termination of efforts [1] considered a class IIb intervention [2] high dose epinephrine: 2-5 mg IV push every 3-5 min; 1 mg, 3 mg, 5 mg 3 minutes apart; 0.1 mg/kg every 3-5 min [3] NaHCO3 not indicated early in resuscitation, acidosis is generally secondary to inadequate ventilation, dose is 1 meq/kg IV followed by 0.5 meq/kg every 0 min

Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 177-178
Journal Watch 24(4):29, 2004 Wenzel V et al, N Engl J Med 350:105, 2004 PMID: [1] McIntyre KM, N Engl J Med 350:179, 2004

asystole