Why is asystole not a shockable rhythm?
Treatment. PEA is treated much like asystole. It is not a shockable rhythm because the electrical system in the heart is actually working properly. Shocking the patient is done to 'reset' the heart's rhythm, but the problem in PEA isn't in the conduction of electrical stimuli in the heart.
Asystole may be treated with 1 mg epinephrine by IV every 3–5 minutes as needed. 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.
- The advanced cardiac life support (ACLS) 2010 guidelines allow vasopressin 40 IU IV as a 1-time dose treatment option in VF and asystole. This treatment can be given either before epinephrine or after the first dose of epinephrine.
- Medically, a “flat-line” is known as asystole, meaning no (heart) contraction. It might seem common sense that if there is no contraction you might want to contract it with a shock. The truth about why this will never “restart” the heart lies in how the heart creates its life giving beat.
- Asystole is defined as a cardiac arrest rhythm in which there is no discernible electrical activity on the ECG monitor. Asystole is sometimes referred to as a “flat line.” Confirmation that a “flat line” is truly asystole is an important step in the ACLS protocol.
The advanced cardiac life support (ACLS) 2010 guidelines allow vasopressin 40 IU IV as a 1-time dose treatment option in VF and asystole. This treatment can be given either before epinephrine or after the first dose of epinephrine.
- After 2 minutes the AED will say “Stop CPR, analysing” The AED is now analysing the victim to see whether a shockable rhythm is present and instruct you again either “ Shock advised” or “No Shock advised”, continue CPR in intervals of 2 mins or until help arrives.
- It almost always refers to either a flatlined electrocardiogram, where the heart shows no electrical activity (asystole), or to a flat electroencephalogram, in which the brain shows no electrical activity (brain death). Both of these specific cases are involved in various definitions of death.
- Advanced cardiac life support or advanced cardiovascular life support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life-threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.
Treatment of Ventricular Fibrillation (VF) and Pulseless Ventricular Tachycardia (VT) is included in the Cardiac Arrest Algorithm. VF and pulseless VT are shockable rhythms and treated in similar fashion. Asystole and PEA are also included in the cardiac arrest algorithm but are nonshockable rhythms.
- The cardiac arrest treatment algorithm divides cardiopulmonary resuscitation into the treatment of shockable rhythms - ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) (Figure 1); and the treatment of non-shockable rhythms - asystole and pulseless electrical activity (PEA) (Figure 2).
- The H's and T's of ACLS is a mnemonic used to help recall the major contributing factors to a pulseless cardiac arrest including PEA, Asystole, Ventricular Fibrillation, and Ventricular Tachycardia. The H's include : Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper/hypokalemia, Hypoglycemia, Hypothermia.
- Cardioversion itself is a very quick procedure, taking only a few minutes. However, you should expect to stay at the hospital for four to six hours, which includes preparation and recovery time.
Updated: 6th October 2019