Asystole

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Asystole
Other namesCardiac flatline, asystolic arrest
A rhythm strip showing two beats of normal sinus rhythm followed by an atrial beat and asystole
Pronunciation
SpecialtyCardiology Edit this on Wikidata

Asystole (New Latin, from Greek

general anesthesia during surgery necessitating stopping the heart). Asystole is the most serious form of cardiac arrest and is usually irreversible. Also referred to as cardiac flatline, asystole is the state of total cessation of electrical activity from the heart
, which means no tissue contraction from the heart muscle and therefore no blood flow to the rest of the body.

Asystole should not be confused with very brief pauses below 3 seconds in the heart's electrical activity that can occur in certain less severe abnormal rhythms. Asystole is different from very fine occurrences of ventricular fibrillation, though both have a poor prognosis, and untreated fine VF will lead to asystole. Faulty wiring, disconnection of electrodes and leads, and power disruptions should be ruled out.

Asystolic patients (as opposed to those with a "shockable rhythm" such as coarse or fine ventricular fibrillation, or unstable

high blood pressure.[4]

Asystole is treated by

hypokalaemia). Several interventions previously recommended—such as defibrillation (known to be ineffective on asystole, but previously performed in case the rhythm was actually very fine ventricular fibrillation) and intravenous atropine—are no longer part of the routine protocols recommended by most major international bodies.[6] 1 mg epinephrine by IV every 3–5 minutes is given for asystole.[7]

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. Even in those cases where an individual suffers a cardiac arrest with asystole and it is converted to a less severe shockable rhythm (ventricular fibrillation, or ventricular tachycardia), this does not necessarily improve the person's chances of survival to discharge from the hospital, though if the case was witnessed by a civilian, or better, a paramedic, who gave good CPR and cardiac drugs, this is an important confounding factor to be considered in certain select cases.[8] Out-of-hospital survival rates (even with emergency intervention) are less than 2 percent.[9]

Cause

Possible underlying causes, which may be treatable and reversible in certain cases, include the Hs and Ts.[10][11][12]

While the heart is asystolic, there is no blood flow to the brain unless

persistent vegetative state.[13]

  • ECG lead showing asystole (flatline)
    ECG lead showing asystole (flatline)
  • Asystole
    Asystole
  • Ventricular fibrillation
    Ventricular fibrillation

See also

References

  1. ^ Harper, Douglas. "asystole". Online Etymology Dictionary.
  2. Perseus Project
    .
  3. PMID 27484660
    .
  4. PMID 21844108
    .
  5. S2CID 58580872
    .
  6. PMID 20956224
    .
  7. PMID 28613616
    .
  8. PMID 23454257
    .
  9. doi:10.1097/01.SA.0000318635.97636.a6
    .
  10. ISBN 978-0-87493-341-3
    .
  11. ISBN 978-0-87493-424-3
    .
  12. PMID 16314375
    .
  13. ^ Shah, Sandy (16 October 2021). "Asystole: Background, Pathophysiology, Etiology". eMedicine.

External links

Wikimedia Commons has media related to Asystole.
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