EKG

Asystole

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Asystole

  • See Also
  1. Cardiopulmonary Resuscitation
  2. Ventricular Fibrillation
  3. Pulseless Ventricular Tachycardia
  • Causes
  1. See Reversible Causes of Cardiopulmonary Arrest (5H5T)
  • Management
  • Adults and Children (Asystole and PEA management are identical)
  1. Continue CPR with high quality Cardiac Compressions
  2. Atropine is no longer recommended in the 2010 Guidelines
  3. Adjunctive measures
    1. Endotracheal Intubation immediately
    2. Obtain IV Access
  4. Evaluate rhythm
    1. Confirm Asystole in more than one lead
    2. Consider Asystole causes as above
  5. Epinephrine every 3-5 minutes
    1. Child
      1. IV/IO: 0.01 mg/kg (0.1 ml/kg of 1:10,000)
      2. ET: 0.1 mg/kg (0.1 ml/kg of 1:1000)
    2. Adult
      1. IV/IO: Epinephrine 1 mg
      2. Consider Vasopressin as alternative to Epinephrine
        1. Dose 40 Units IV for single, one time dose in place of first or second Epinephrine dose
        2. Considered superior to Epinephrine in Asystole
        3. Zepf (2003) N Engl J Med 350:105-13 [PubMed]
  6. Consider immediate Transcutaneous Pacing
    1. Indicated if reversible cause with decisive management (e.g. revascularization for acute MI)
    2. Pediatric electrodes indicated if <15 kg
  7. Consider termination of efforts
    1. Asystole refractory to above measures
    2. No reversible causes identified
  • References
  1. Pediatric Resucitation
    1. http://pediatrics.aappublications.org/content/126/5/e1361.full.html
    2. (2010) Pediatrics 126(5): e1361 [PubMed]
  2. Cardiopulmonary Resuscitation Guidelines
    1. http://www.circulationaha.org
    2. (2010) Guidelines for CPR and ECC [PubMed]
    3. (2005) Circulation 112(Suppl 112):IV [PubMed]
    4. (2000) Circulation, 102(Suppl I):86-9 [PubMed]