Asystole

In medicine, asystole /!!s"st!li#/, colloquially known as flatline, is a state of no cardiac electrical activity,
hence no contractions of the myocardium and no cardiac output or blood flow. Asystole is one of the
conditions that may be used for a medical practitioner to certify clinical or legal death.
Asystole is treated by cardiopulmonary resuscitation (CPR) combined with an intravenous vasopressor
such as epinephrine (adrenaline). Sometimes an underlying reversible cause can be detected and treated
(the so-called 'H's and T's', an example of which is hypokalaemia). Several interventions previously
recommendedsuch as defibrillation (known to be ineffective on asystole, but previously performed in
case the rhythm is actually fine ventricular fibrillation) and intravenous atropineare no longer part of
the routine protocols recommended by most major international bodies.
[1]
Asystole may be treated with 1
mg epinephrine by IV every 3-5 minutes as needed. Vasopressin 40 units by IV every 3-5 minutes may be
used in place of the first and/or second doses of epinephrine, but doing so does not enhance outcomes.
Survival rates in a cardiac arrest patient with asystole are much lower than a patient with a rhythm
amenable to defibrillation; asystole is itself not a "shockable" rhythm. Out-of-hospital survival rates (even
with emergency intervention) are less than 2 percent.
[2]
Cause
Possible underlying causes include the Hs and Ts.
[3][4][5]
Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
Hypothermia
Hyperkalemia or hypokalemia
Hypoglycemia
Tablets or toxins (drug overdose)
Cardiac Tamponade
Tension pneumothorax
Thrombosis (myocardial infarction)
Thrombosis (pulmonary embolism)
Trauma (hypovolemia from blood loss)
While the heart is asystolic, there is no blood flow to the brain unless CPR or internal cardiac massage
(when the chest is opened and the heart is manually compressed) is performed, and even then it is a small
amount. After many emergency treatments have been applied but the heart is still unresponsive, it is time
to consider pronouncing the patient dead. Even in the rare case that a rhythm reappears, if asystole has
persisted for fifteen minutes or more the brain will have been deprived of oxygen long enough to cause
brain death.
ECG lead showing Asystole (Flatline)
See also
Agonal heart rhythm
Cardiac arrest
Myocardial infarction
Ventricular fibrillation
References