Background

Asystole is cardiac standstill with no cardiac output

and no ventricular depolarization, as shown in the
image below; it eventually occurs in all dying
patients.

Rhythm strip showing asystole.
Rhythm strip showing asystole.
Pulseless electrical activity (PEA) is the term
applied to a heterogeneous group of dysrhythmias
unaccompanied by a detectable pulse.
Bradyasystolic rhythms are slow rhythms; they can
have a wide or narrow complex, with or without a
pulse, and are often interspersed with periods of
asystole. When discussing pulseless electrical
activity, ventricular fibrillation (VF) (see the
following image) and ventricular tachycardia (VT)
are excluded.

Rhythm strip showing ventricular fibrillation.
Rhythm strip showing ventricular fibrillation.
Pathophysiology
Asystole can be primary or secondary. Primary
asystole occurs when the heart's electrical system
intrinsically fails to generate a ventricular
depolarization. This may result from ischemia or
from degeneration (ie, sclerosis) of the sinoatrial
(SA) node or atrioventricular (AV) conducting
system. Primary asystole is usually preceded by a
bradydysrhythmia due to sinus node block-arrest,
complete heart block, or both.

Reflex bradyasystole/asystole can result from
ocular surgery,[1, 2] retrobulbar block, eye trauma,
direct pressure on the globe, maxillofacial surgery,
hypersensitive carotid sinus syndrome, or
glossopharyngeal neuralgia. Episodes of asystole
and bradycardia have been documented as
manifestations of left temporal lobe complex partial
seizures.[3] These patients experienced either
dizziness or syncope. No sudden deaths were
reported, but the possibility exists if asystole were
to persist. The longest interval was 26 seconds.

Secondary asystole occurs when factors outside of
the heart's electrical conduction system result in a
failure to generate any electrical depolarization. In
this case, the final common pathway is usually
severe tissue hypoxia with metabolic acidosis.
Asystole or bradyasystole follows untreated
fundal
Asistola este oprit cardiac fr debitul cardiac i nu
depolarizare ventricular , aa cum se arat n
imaginea de mai jos , ea apare n cele din urm la
toti pacientii mor .

Benzi ritm arat asistolie .
Benzi ritm arat asistolie .
Activitate electric fr puls ( AEP ) este termenul
aplicat la un grup heterogen de aritmii neinsotiti de
un impuls detectabil . Ritmurile Bradyasystolic
sunt ritmurile lente , ele pot avea un complex larg
sau ngust , cu sau fr un impuls , i sunt adesea
intercalate cu perioade de asistolie . Atunci cnd se
discut activitate electric fr puls , fibrilaie
ventricular ( VF ) ( vezi imaginea de mai jos ), i
tahicardie ventricular ( VT ) sunt excluse .

Benzi ritm arat fibrilatie ventriculara .
Benzi ritm arat fibrilatie ventriculara .
Fiziopatologie
Asistola poate fi primar sau secundar . Asistola
primar apare cand sistemul electric al inimii
intrinsec nu reuete s genereze o depolarizare
ventriculara . Acest lucru poate duce la ischemie
sau de degenerare ( de exemplu , scleroza )
dinsinoatrial ( SA ) sau nodul atrioventricular ( AV
) efectuarea sistem . Asistola primar este de obicei
precedat de o bradydysrhythmia din cauza nodului
sinusal Block - stop , bloc cardiac complet , sau
ambele .

Bradyasystole Reflex / asistola poate duce la
interventii chirurgicale oculare , [ 1 , 2 ] bloc
retrobulbar , traumatisme oculare , presiune direct
pe glob , Chirurgie maxilo-faciala , sindrom de
hipersensibilitate sinusului carotidian , sau
nevralgie glosofaringian . Episoadele de asistolie i
bradicardie au fost documentate ca manifestri ale
stanga lobul temporal crize epileptice pariale
complexe [ 3 ] Aceti pacieni au prezentat fie
ameeal sau sincop . . Nu au fost raportate decese
bruste , dar exist posibilitatea , dac asistola ar
persista . Cel mai lung interval a fost de 26
secunde.

Asistola secundar apare atunci cnd factori din
afara inimii electric rezultat sistem de conducere
ntr- un eec de a genera orice depolarizare
electric . n acest caz , calea finala comuna este ,
de obicei, hipoxie tisular sever cu acidoz
ventricular fibrillation and commonly occurs after
unsuccessful attempts at defibrillation. This
forebodes a dismal outcome.

Etiology
Causes of primary and secondary asystole are
briefly reviewed in this section.

Primary asystole
Primary asystole develops when cellular metabolic
functions are no longer intact and an electrical
impulse cannot be generated. With severe ischemia,
pacemaker cells cannot transport the ions necessary
to affect the transmembrane action potential.
Implantable pacemaker failure may also be a cause
of primary asystole.

Proximal occlusion of the right coronary artery can
cause ischemia or infarction of both the sinoatrial
(SA) and the atrioventricular (AV) nodes.
Extensive infarction can cause bilateral bundle-
branch block (ie, infranodal complete heart block).

Idiopathic degeneration of the SA or AV node can
result in sinus arrest-block and/or AV heart block,
respectively. This process is slow and progressive,
but the symptoms may be acute and asystole may
result. An implantable pacemaker is usually
required for these conditions.

Occasionally, asystolic sudden death occurs from
congenital heart block, local tumor, or cardiac
trauma.[4]

Asystole can occur following an indirect lightning
strike (ie, direct current [DC]) that depolarizes all
the cardiac pacemakers. A rhythm may return
spontaneously or shortly after cardiopulmonary
resuscitation (CPR) is initiated. These patients may
survive intact if given immediate attention.
Alternating current (AC) from man-made sources
of electrical current usually results in ventricular
fibrillation (VF).

Secondary asystole
Examples of common conditions that can result in
secondary asystole include suffocation, near
drowning, stroke, massive pulmonary embolus,
hyperkalemia, hypothermia, myocardial infarction
(MI) complicated by VF or ventricular tachycardia
(VT) that deteriorates to asystole, post
metabolic . Asistola sau bradyasystole urmeaz
fibrilaie ventricular netratate i de obicei apare
dup ncercri nereuite la defibrilare . Aceasta
forebodes un rezultat sumbru .

etiologie
Cauzele de asistolie primar i secundar sunt
analizate pe scurt n aceast seciune .

asistola primar
Asistola primar se dezvolta atunci cand functiile
metabolice celulare nu mai sunt intacte i un impuls
electric nu poate fi generat . Cu ischemie sever ,
celulele stimulator cardiac nu poate transporta ionii
necesare pentru a afecta potenialul aciunii
transmembranar . Eec stimulator cardiac
implantabil ar putea fi , de asemenea, o cauza de
asistolie primar .

Ocluzie proximal alarterei coronare drepte poate
provoca ischemie sau infarct att a sinoatriale ( SA
) iatrioventricular noduri ( AV ) . Infarct extins
poate provoca bloc bilateral de ramur ( de
exemplu , bloc cardiac complet infranodal ) .

Degenerare idiopatica a nodului SA sau AV poate
duce la sinusal , bloc i / sau bloc cardiac AV ,
respectiv . Acest proces este lent i progresiv , dar
simptomele pot fi acute i asistolie poate duce . Un
stimulator cardiac implantabil este de obicei
necesar pentru aceste condiii .

Ocazional , moarte subit asystolic are loc de la
bloc cardiace congenitale , tumori locale , sau
traumatisme cardiace . [ 4 ]

Asistola poate aprea ca urmare a unei lovituri de
trsnet indirecte ( de exemplu , curent continuu [
DC ] ) c depolarizes toate stimulatoarele cardiace .
Un ritm poate reveni spontan sau la scurt timp dup
resuscitare cardiopulmonara ( CPR ) este iniiat .
Aceti pacieni pot supravieui intact n cazul dat
atenie imediat . Curent alternativ ( AC ) de la
surse artificiale de curent electric , de obicei,
rezultate n fibrilaie ventricular ( VF ) .

asistola secundar
Exemple de condiii comune care pot duce la
asistolie secundare includ sufocare , aproape de
inec , accident vascular cerebral , embolie
pulmonar masiv , hiperkaliemia , hipotermie ,
defibrillation, and sedative-hypnotic or narcotic
overdoses leading to respiratory failure.

Hypothermia is a special circumstance, because
asystole can be tolerated for a longer period under
such conditions and can be reversed with rapid
rewarming while CPR is being performed. If
available, institute cardiopulmonary bypass
immediately, because it can accomplish both of
these goals. Most survivors have received
cardiopulmonary bypass.

Epidemiology
The number of US adults in cardiopulmonary arrest
who had bradyasystole as the initial arrest rhythm
is difficult to measure accurately. Reports vary and
may be skewed by the patient population studied
and/or by the method of reporting the initial
rhythm. For example, in a 1991 study of 185
patients in cardiopulmonary arrest at the time of
arrival to the emergency department, 9% had
survived to hospital admission but none were
discharged alive.[5] This study was not limited to
patients with asystole.[5] In one study from
Goteborg, Sweden, asystole was the presenting
rhythm in the field in 35% of patients with cardiac
arrest.[6]

Race is not a significant factor in asystole except as
it relates to the underlying conditions that may lead
to a cardiac arrest, such as chronic hypertension,
renal failure, coronary artery disease, congestive
heart failure, or cardiac dysrhythmias.

Individuals with low CAD incidence
When the incidence of coronary artery disease
(CAD) in the population of a country is relatively
low, asystole is relatively more common as a
manifestation of cardiopulmonary arrests. This is
because cardiac ischemia more frequently results in
ventricular fibrillation (VF).

Children
The prevalence of asystole as the presenting
cardiac rhythm is lower in adults (25-56%) than in
children (90-95%). In fact, asystole is most likely
to be found in cardiopulmonary arrests occurring in
children; this is usually secondary to another
noncardiac event (ie, respiratory arrest due to
sudden infant death syndrome [SIDS], infection,
choking, drowning, or poisoning).[7] Infants are
infarct miocardic (IM ), complicat cu VF sau
tahicardie ventricular ( VT ), care se deterioreaza
la asistolie , dup defibrilare , i sedative -
hipnotice supradoze sau narcotice care duc la
insuficien respiratorie.

Hipotermia este o situaie special , deoarece
asistola poate fi tolerat pentru o perioad mai lung
n aceste condiii i poate fi inversat cu rewarming
rapid n timp ce CPR este efectuat . Dac sunt
disponibile , Institutul de by-pass cardiopulmonare
imediat , deoarece se poate realiza ambele obiective
. Cei mai multi supravietuitori au primit by-pass
cardiopulmonare .

Epidemiologie
Numrul de adulti din SUA n stop cardio-
respirator , care a avut bradyasystole ca ritmul
iniial de arestare este dificil de msurat cu
exactitate . Rapoarte variaz i poate fi nclinat
cupopulaiei din studiile clinice i / sau prinmetoda
de raportareritmul iniial . De exemplu , ntr -un
studiu de 1991 de 185 de pacienti in stop cardio-
respirator la momentul sosirii la departamentul de
urgenta , 9 % au supravietuit de admitere spital, dar
nici nu au fost evacuate n via . [ 5 ] Acest studiu
nu a fost limitata la pacientii cu asistolie . [ 5 ] ntr-
un studiu de la Goteborg , Suedia , asistola a fost
ritmul prezentrii n domeniul de la 35 % dintre
pacientii cu stop cardiac . [ 6 ]

Rasa nu este un factor important n asistolie cu
excepia celor care se refer la condiiile de baz
care pot duce la un stop cardiac , cum ar fi
hipertensiune arteriala cronica , insuficienta renala ,
boli coronariene , insuficienta cardiaca congestiva ,
sau aritmii cardiace .

Persoanele cu inciden sczut CAD
Cnd incidenta bolii coronariene ( CAD ) n
populaia unei ri este relativ sczut , asistola este
relativ mai frecvent ca o manifestare de arestari
cardiorespirator . Acest lucru se datoreaz faptului
c ischemia cardiac mai frecvent rezultat n
fibrilaie ventricular ( VF ) .

copii
Prevalenta de asistolie ca ritmul cardiac prezentarea
este mai mic la aduli ( 25-56 % ) dect la copii (
90-95 % ) . De fapt , asistola este cel mai probabil
s fie gsit n arestari cardiorespirator care apar la
more statistically likely to suffer a cardiac arrest
than older children or adolescents.

The Resuscitation Outcomes Consortium Epistry-
Cardiac Arrest trial, nontraumatic cardiac arrest
occurred at a rate of 72.1 per 100,000 infants
versus 3.73 per 100,000 in children and 7.37 per
100,000 in adolescents.[8] Investigators found the
adult rate of cardiac arrest was 126.52 per 100,000
when they evaluated 25,405 adults and 624 patients
younger than 20 years.

Pediatric patients with VF or ventricular
tachycardia (VT) were 4 times more likely to
survive an out-of-hospital cardiac arrest (20%) than
those with asystole (5%), and patients younger than
20 years had an overall better survival rate than
adults when all rhythms are included and traumatic
arrests are excluded.[8]

Women
The frequency of asystole, as a percentage of all
cardiopulmonary arrests, is higher in women than
in men; however, the frequency of cardiac arrest in
general is proportional to the underlying incidence
of heart disease, which is more common in males
until around age 75 years.

Prognosis
The prognosis in asystole depends on the etiology
of the asystolic rhythm, timing of interventions,
and success or failure of advanced cardiac life
support (ACLS).

Resuscitation is likely to be successful only if it is
secondary to an event that can be corrected
immediately, such as a cardiac arrest due to
choking on food (a cafe coronary), and only if an
airway can be established and the patient may be
rapidly reoxygenated. Occasionally, primary
asystole can be reversed if it is due to pacemaker
failure, which could be either intrinsic or extrinsic,
and this is corrected immediately by external
pacing.

Generally, the prognosis is dismal regardless of its
initial cause; in particular, individuals with
postcountershock asystole have an even worse
survival rate.[9, 10] In the Termination of
Resuscitation study, when no shock was advised in
patients with unwitnessed cardiac arrest, there were
copii , aceasta este, de obicei secundara la un alt
eveniment noncardiac ( de exemplu , stop respirator
ca urmare a sindromului de moarte subita a
sugarului [ SIDS ] , infectii , sufocare , inec , sau
otrvire ) . [ 7 ] Sugarii sunt mai mult statistic
susceptibile de a suferi un stop cardiac decat copiii
mai mari sau adolesceni .

Reanimare Rezultate Consortiul proces de arestare
Epistry - cardiac , stop cardiac nontraumatic a avut
loc la o rata de 72,1 la 100.000 de nou-nascuti fata
de 3.73 la 100.000 la copii i 7.37 la 100.000 in
randul adolescentilor . [ 8 ] Anchetatorii au
constatat tariful de adult de stop cardiac a fost de
126.52 la 100.000 atunci cnd a evaluat 25405
adulti si 624 de pacienii mai tineri de 20 de ani .

Copii si adolescenti cu FV sau tahicardie
ventricular ( VT ) au fost de 4 ori mai multe sanse
de a supravietui unui stop cardiac out-of - spital (
20 % ) dect cei cu asistolie ( 5 % ) , iar cei mai
tineri de 20 de ani a avut o rata globala de
supravietuire mai bine dect adulii atunci cnd
toate ritmurile sunt incluse i sunt excluse arestri
traumatice . [ 8 ]

femei
Frecvena de asistolie , ca un procent din toate
arestari cardiorespirator , este mai mare la femei
dect la brbai , cu toate acestea , frecvena de stop
cardiac , n general, este proporional cu incidena
stau la baza bolilor de inima , care este mai
frecventa la barbati pana in jurul varstei de 75 de
ani .

prognoz
Prognosticul n asistolie depinde de etiologia ritm
asystolic , calendarul de intervenii , i succesul sau
eecul de suport vital avansat cardiac ( ACL-uri ) .

Resuscitare este probabil s fie de succes numai
dac acesta este secundar la un eveniment care pot
fi corectate imediat , cum ar fi un stop cardiac din
cauza sufocare pe produse alimentare ( o cafenea
coronare ) , i numai n cazul n care o cailor
respiratorii poate fi stabilit , iar pacientul poate fi
rapid reoxygenated . Ocazional , asistola primar
poate fi inversat dac este din cauza unor defeciuni
stimulator cardiac , care ar putea s fie intrinsec sau
extrinsec , iar acest lucru este corectat imediat de
stimulare extern .
no survivors.[11, 12] In the Goteborg, Sweden,
study, 10% of 1,635 asystolic patients survived to
hospital admission, but 2% survived to hospital
discharge.[6]

The most recent American Heart Association
guidelines to improve cardiocerebral resuscitation
(CCR) have validated studies that show improved
outcomes in all adults with out-of-hospital cardiac
arrest in ventricular tachycardia and ventricular
fibrillation only.[13]

Complications
Complications from asystole include permanent
neurologic impairment and complications from
cardiopulmonary resuscitation (CPR) or invasive
procedures (eg, liver laceration, fractured ribs,
pneumothorax, hemothorax, air embolus,
aspiration, gastric/esophageal rupture). Death often
occurs.

Patient Education
Advice about electrical storm safety and prevention
of hypothermia is appropriate for those likely to be
exposed to these conditions.

For patient education information, see Heart Health
Center as well as Cardiopulmonary Resuscitation
(CPR), Heart Attack, and Coronary Artery Disease.

n general , prognosticul este sumbru , indiferent de
cauza iniial ; . n special , persoanele cu asistola
postcountershock au o rata de supravietuire mai rau
[ 9 , 10 ] la rezilierea de studiu resuscitare , atunci
cnd nu oc a fost recomandat la pacientii cu stop
cardiac nemarturisit , nu au existat supravieuitori .
[ 11 , 12 ] n Goteborg , Suedia , de studiu , 10 %
din 1635 pacienti asystolic supravietuit la admitere
spital , dar 2 % supravietuit pana la externare . [ 6 ]

Cele mai recente ale Americii de Heart Association
pentru a mbunti resuscitare cardiocerebral (
CCR ) au validat studii care arata rezultate
imbunatatite la toti adultii cu stop cardiac out-of -
spital n tahicardia ventricular i fibrilaia
ventricular numai . [ 13 ]

complicatiile
Complicatiile de la asistolie includ tulburri
neurologice permanente si complicatii de la
resuscitare cardiopulmonara ( CPR ) sau proceduri
invazive ( de exemplu , rupturilor ficat , coaste
fracturate , pneumotorax , hemotorax , embolie de
aer , aspiraie , gastric / ruptura esofagiana ) .
Moartea apare de multe ori .

educatia pacientului
Sfaturi despre siguranta furtuni cu descrcri
electrice i de prevenire a hipotermiei este potrivit
pentru cei care pot fi expui la aceste condiii .

Pentru informaii educatie pacientului , a se vedea
inima Centrul de Sanatate , precum si resuscitare
cardiopulmonara ( CPR ) , atac de cord, si de boli
coronariene .