Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020. If you are reading this page after October 2020, please contact ACLS Training Center at firstname.lastname@example.org for an updated document.
Management of a patient in cardiac arrest with asystole follows the same pathway as management of PEA. The top priorities stay the same: Following the steps in the ACLS Pulseless Arrest Algorithm and identifying and correcting any treatable, underlying causes for the asystole. The algorithm assumes that scene safety has been assured, personal protective equipment is being used, and no signs of obvious death are present.
Begin with the primary survey to assess the patient's condition:
- In the absence of respirations and a pulse in the presence of asystole (present in two leads) consideration of termination of efforts should take place.
Follow the ACLS Pulseless Arrest Algorithm for asystole:
- Check the patient's rhythm, taking less than 10 seconds to assess.
- Verify the presence of asystole in at least two leads.
- Resume CPR at a compression rate from 100-120 per minute. Rotate team members every 2 minutes with rhythm breaks to help maintain high quality CPR.
- As soon as IV or IO access is available, administer epinephrine 1mg IV/IO. Do not stop CPR to administer drugs.
- During CPR, search for and treat possible contributing causes (see "Reversible Causes", H's and T's in the PDF version).
- If no electrical activity is present (patient is in asystole), resume CPR.
- If electrical activity is present, see if the patient has a pulse.
- If the patient does not have a pulse or there is some doubt about the pulse, resume CPR.
- If a good pulse is present and the rhythm is organized, begin post-resuscitative care.
IV/IO access is a priority over advanced airway management. If an advanced airway is placed, change to continuous chest compressions without pauses for breaths. Give 10 breaths per minute (once every 6 seconds) and check rhythm every 2 minutes.
Without a pulse or electrical activity on the ECG, the emergency care team needs to decide when resuscitation efforts should stop. The patient's wishes and the family's concerns need to be considered.