Version control: This document is current with respect to the latest 2016 American Heart Association® Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 21, 2020. If you are reading this page after October 21, 2020, please contact ACLS Training Center at 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:

Follow the ACLS Pulseless Arrest Algorithm for asystole:

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.