ADVANCED CARDIAC

LIFE SUPPORT

ASYSTOLE
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 Learning Objectives
1. Identify Asystole and apply the ACLS
approach(Primary and Sceondary ABCD
Surveys) to a patient in asystole.
2. Emphasis on CPR and drugs in the
management of asystolic patients
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Clinical Scenario
A 67 y/o man was immediately brought to the
ER after he was seen unconscious by
bystanders. On examination he has no BP, no
pulse, no respiration and flat line on cardiac
monitor. The next best thing we should do in
this case?
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PRIMARY ABCD SURVEY
Focus: basic CPR and defibrillation
. Check responsiveness
. Activate emergency response team
. Call for defibrillator
A Airway: open the airway
B Breathing: provide positive pressure ventilation
C Circulation: give chest compressions
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PRIMARY ABCD SURVEY
C Confirm: true asystole
D Defibrillation: assess for VF/pulseless VT,
shock if indicated
Rapid scene survey: is there any evidence that
personnel should not attempt resuscitation
(DNR order, signs of death)
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SECONDARY ABCD SURVEY
Focus: more advanced assessments and treatments
A Airway: place airway device as soon as possible
B Breathing: confirm airway device placement by
exam plus confirmation device
B Breathing: secure airway device; purpose-made
tube holders preferred
B Breathing: confirm effective oxygenation and
ventilation
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SECONDARY ABCD SURVEY
C Circulation: confirm true asystole
C Circulation: establish IV access
C Circulation: identify rhythm monitor
C Circulation: give medications appropriate for
rhythm and condition
D Differential diagnosis: search for and treat
identifiable reversible causes
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Resume CPR immediately for 5
cycles/Simultaneous intubation
When IV/IO available, give vasopressor
. Epinephrine 1 mg/IV/IO
Repeat every 3 to 5 minutes or
. May give 1 dose of vasopressin 40 U IV/IO to
replace first or second dose of epinephrine
Consider atropine 1 mg/IV/IO for asystole or slow
PEA rate
Repeat every 3 to 5 minutes( up to 3 doses or
maximum of 3 mg or .04 mg/kg
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Every after 5 cycles of CPR(~ 2min.) do rhythm
check and apply approriate ACLS algorithm
If ASYSTOLIC, repeat cycle( CPR-drug-CPR…)
If asystole persists- withhold or cease resuscitation
efforts
. Consider quality of resuscitation
. Support for cease protocols in place
. Consensus of legal representative of the deceased
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 Things to remember
Adequate chest compressions is tantamount to adequate
blood flow/circulation; it includes
1. Push hard and fast (100/min)( 2 or multiple rescuer)
2. Full chest recoil- allowance of ventricular filling(pre-
load)
3. No interruptions in chest compression
4. One cycle of CPR: 30 compressions is to 2 breaths; 5
cycles= 2 min.(Single rescuer)
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 No more delivery of “cycles of CPR” once
advanced airway is inserted
 Continous chest compressions without pauses
for breaths( 8-10 breaths minute)
 Avoid hyperventilation( each breath to be
delivered for 1-2 sec)
 Every 2 minutes we check for rhythm, rotate
compressors and complete 5 cycles of CPR
 DO NOT SHOCK ASYSTOLE
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 Search for and treat contributory and possible
reversible factors
5 H’S
.Hypovolemia
.Hypoxia
.Hydrogen ion(acidosis)
.Hypo/hyperkalemia
.Hypothermia
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 5 T’s
. Toxins
. Tamponade, cardiac
. Tension Pneumothorax
. Thrombosis(Coronary/pulmonary)
. Trauma
THANK YOU