II. Causes
III. Management: Adults and Children (Asystole and PEA management are identical)
- Continue CPR with high quality Cardiac Compressions
- Atropine is no longer recommended in the 2010 Guidelines
- Adjunctive measures
- Endotracheal Intubation immediately
- Obtain IV Access
- Evaluate rhythm
- Confirm Asystole in more than one lead
- Consider Asystole causes as above
-
Epinephrine every 3-5 minutes
- Child
- IV/IO: 0.01 mg/kg (0.1 ml/kg of 1:10,000)
- ET: 0.1 mg/kg (0.1 ml/kg of 1:1000)
- Adult
- IV/IO: Epinephrine 1 mg
- Consider Vasopressin as alternative to Epinephrine
- Dose 40 Units IV for single, one time dose in place of first or second Epinephrine dose
- Considered superior to Epinephrine in Asystole
- Zepf (2003) N Engl J Med 350:105-13 [PubMed]
- Child
- Consider immediate Transcutaneous Pacing
- Indicated if reversible cause with decisive management (e.g. revascularization for acute MI)
- Pediatric electrodes indicated if <15 kg
- Consider termination of efforts
- Asystole refractory to above measures
- No reversible causes identified
IV. References
- Pediatric Resucitation
- Cardiopulmonary Resuscitation Guidelines