III. Management: Adults and Children (Asystole and PEA management are identical)

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

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Ontology: Cardiac Arrest (C0018790)

Definition (MSHCZE) Zastavení srdečního rytmu nebo stahů (MYOKARD – KONTRAKCE). Je-li srdeční činnost obnovena během několika minut, může být srdeční zástava ve většině případů bez následků obrácena zpět do normálního srdečního rytmu a tím i krevního oběhu. R
Definition (MEDLINEPLUS)

The heart has an internal electrical system that controls the rhythm of the heartbeat. Problems can cause abnormal heart rhythms, called arrhythmias. There are many types of arrhythmia. During an arrhythmia, the heart can beat too fast, too slow, or it can stop beating. Sudden cardiac arrest (SCA) occurs when the heart develops an arrhythmia that causes it to stop beating. This is different than a heart attack, where the heart usually continues to beat but blood flow to the heart is blocked.

There are many possible causes of SCA. They include coronary heart disease, physical stress, and some inherited disorders. Sometimes there is no known cause for the SCA.

Without medical attention, the person will die within a few minutes. People are less likely to die if they have early defibrillation. Defibrillation sends an electric shock to restore the heart rhythm to normal. You should give cardiopulmonary resuscitation (CPR) to a person having SCA until defibrillation can be done.

If you have had an SCA, an implantable cardiac defibrillator (ICD) reduces the chance of dying from a second SCA.

NIH: National Heart, Lung, and Blood Institute

Definition (NCI_CDISC) Cardiac arrest is the non-fatal, sudden cessation of cardiac activity so that the victim subject/patient becomes unresponsive, with no normal breathing and no signs of circulation. Cardiac arrest should be used to signify an event as described above that is reversed, usually by CPR, and/or defibrillation or cardioversion, or cardiac pacing.
Definition (NCI_CTCAE) A disorder characterized by cessation of the pumping function of the heart.
Definition (NCI_FDA) Sudden cessation of the pumping function of the heart, with disappearance of arterial blood pressure, connoting either ventricular fibrillation or ventricular standstill.
Definition (NCI) The sudden cessation of cardiac activity in an individual who becomes unresponsive, without normal breathing and no signs of circulation. Cardiac arrest may be reversed by CPR, and/or defibrillation, cardioversion or cardiac pacing.
Definition (CSP) cessation of the heart beat.
Definition (MSH) Cessation of heart beat or MYOCARDIAL CONTRACTION. If it is treated within a few minutes, heart arrest can be reversed in most cases to normal cardiac rhythm and effective circulation.
Concepts Disease or Syndrome (T047)
MSH D006323
ICD9 427.5
ICD10 I46 , I46.9
SnomedCT 251189000, 30298009, 309810002, 195085006, 195090009, 397912004, 155372006, 397829000, 410429000
LNC LP133247-9, MTHU041449, LA17068-0, LA17496-3, LA9535-1
English Arrest, Heart, Asystole, Asystoles, Heart Arrest, ASYSTOLIA, Arrest, Cardiac, VENTRICULAR ASYSTOLIA, Cardiac arrest - asystole, Cardiac arrest, unspecified, CA - Cardiac arrest, Cardiac Arrest, cardiac arrest, cardiac arrest (diagnosis), asystole (diagnosis), asystole, Arrest cardiac, Heart arrest, Ventricular asystole, Asystolia, Ventricular asystolia, Asystolic, Standstill cardiac, Heart Arrest [Disease/Finding], arrest [as an cardiac arrest], asystolia, ventricular asystole, cardiac asystole, heart arrest, arrest, arrested, Cardiac arrest, unspecified (disorder), Asystole (finding), SCA, ASYSTOLE, ARREST, CARDIAC, CARDIAC ARREST, Cardiac arrest- asystole, Cardiac standstill, Asystole (disorder), heart; arrest, heart; stoppage, stoppage; heart, ventricular; arrest, arrest; cardiac, arrest; ventricular, Cardiac arrest, Cardiac arrest (disorder)
French ARRET CARDIAQUE, Asystolie, Arrêt des contractions du coeur, Asystole ventriculaire, Asystolique, Arrêt du coeur, Asystole, ASYSTOLIE VENTRICULAIRE, ASYSTOLIE, Pause cardiaque, Arrêt cardiaque, Arrêt cardio-circulatoire, Arrêt cardiocirculatoire
Portuguese PARADA CARDIACA, Assístolia, Assistólico, ASSISTOLIA VENTRICULAR, ASSISTOLIA, Parada Cardiorrespiratória, Paralisia Cardíaca, Assistolia ventricular, Paragem cardíaca, Assistolia, Parada Cardíaca
Spanish PARO CARDIACO, ASISTOLIA, Asistólico, Paro cardiaco, Asístole, Parada Cardíaca, ASISTOLIA VENTRICULAR, paro cardíaco, no especificado, paro cardíaco, no especificado (trastorno), asístole, Cardiac arrest, unspecified, Parada Cardiorrespiratoria, Parálisis Cardíaca, Parada Cardiopulmonar, Paro Cardiorrespiratorio, asistolia (trastorno), asistolia, Asistolia ventricular, Parada cardiaca, paro cardíaco (trastorno), paro cardíaco, Asistolia, Paro Cardíaco
German HERZSTILLSTAND, Asystolisch, Stillstand Herz, ASYSTOLIE, Herzstillstand, nicht naeher bezeichnet, VENTRIKULAERE ASYSTOLIE, ventrikulaere Asystolie, Asystolie, Herzstillstand, Kardialer Stillstand
Italian Asistole ventricolare, Asistolico, Asistolia, Asistolia ventricolare, Asistole, Arresto cardiaco
Dutch asystolie, ventriculaire asystolie, stilstand van het hart, asystole, asystolisch, hart; stilstand, hart; stoppen, stilstand; hart, stilstand; ventriculair, stoppen; hart, ventriculair; stilstand, Hartstilstand, niet gespecificeerd, hartstilstand, ventriculaire asystole, Arrest, cardiaal, Asystolie, Hartstilstand, Stilstand, hart-
Japanese 心室無収縮, シンシツムシュウシュク, シンテイシ, 心肺停止, 心拍停止, 不全収縮期, シンセイシ, 心静止, 心臓停止, 心停止
Swedish Hjärtstopp
Czech srdce - zástava, Srdeční zástava, Asystolie, Zástava srdce, Komorová asystolie, asystolie
Finnish Sydämenpysähdys
Korean 심장정지, 상세불명의 심장정지
Polish Zatrzymanie czynności serca, Asystolia, Nagłe zatrzymanie krążenia, Zatrzymanie akcji serca
Hungarian Ventricularis asystole, Asystole, Asystoliás, Szívmegállás, Szív nem működik, Asystolia, Szív megállása, Cardialis leállás, Ventricularis asystolia
Norwegian Hjertestans, Hjertestopp, Asystoli