Asystole

Excerpt

Asystole, colloquially referred to as flatline, represents the cessation of electrical and mechanical activity of the heart. Asystole typically occurs as a deterioration of the initial non-perfusing ventricular rhythms: ventricular fibrillation (V-fib) or pulseless ventricular tachycardia (V-tach). Additionally, pulseless electrical activity (PEA) can cease and become asystole. Victims of sudden cardiac arrest who present with asystole as the initial rhythm have an extremely poor prognosis (10% survive to admission, 0 to 2% survival-to-hospital discharge rate). Asystole represents the terminal rhythm of a cardiac arrest.

In out-of-hospital cardiac arrest, prolonged resuscitation efforts in a patient who presents in asystole are unlikely to provide a medical benefit. Termination of resuscitation efforts should be considered in these patients, in consultation with online medical direction, as allowed by local protocols. The American College of Emergency Physicians (ACEP) and National Association of Emergency Medical Services Physicians (NAEMSP) both recommend emergency medical services systems and have written protocols that allow for termination of resuscitation efforts by emergency medical services providers for a select group of patients in which further resuscitative measures and transport to the local emergency department would be considered futile.