AsystoleArhythmstripshowingtwobeatsofnormalsinusrhythmfollowedbyanatrialbeatandasystole.Pronunciation/əˈsɪstəliː/ClassificationandexternalresourcesSpecialtycardiologyICD-10I46.0(http://apps.who.int/classifications/icd10/browse/2016/en#/I46.0)ICD-9-CM427.5(http://www.icd9data.com/getICD9Code.ashx?icd9=427.5)AsystoleFromWikipedia,thefreeencyclopediaAsystole(1860,fromModernLatin,fromGreekα"not,without"+systole"contraction")istheabsenceofventricularcontractionslastinglongerthantheminimumpossibletosustainlife(about2secondsforahuman).Aflatlineisthestateoftotalcessationofelectricalactivityfromtheheart,whichmeansnotissuecontractionfromtheheartmuscleandthereforenobloodflowtotherestofthebody.Asystoleisthemostseriousandirreversibleformofcardiacarrest.Asystolicpatients(asopposedtothosewitha"shockablerhythm"suchasventricularfibrillationorventriculartachycardia,whichcanbepotentiallytreatedwithdefibrillation)usuallypresentwithaverypoorprognosis:asystoleisfoundinitiallyinonlyabout28%ofcardiacarrestcases,[1]butonly15%ofthesepatientseverleavethehospitalalive,evenwiththebenefitofanintensivecareunit,withtheratebeinglower(only6%)forthosealreadyprescribeddrugsforhighbloodpressure.[2]Asystoleistreatedbycardiopulmonaryresuscitation(CPR)combinedwithanintravenousvasopressorsuchasepinephrine(a.k.a.adrenaline).Sometimesanunderlyingreversiblecausecanbedetectedandtreated(theso-called'HsandTs',anexampleofwhichishypokalaemia).Severalinterventionspreviouslyrecommended—suchasdefibrillation(knowntobeineffectiveonasystole,butpreviouslyperformedincasetherhythmwasactuallyveryfineventricularfibrillation)andintravenousatropine—arenolongerpartoftheroutineprotocolsrecommendedbymostmajorinternationalbodies.[3]Asystolemaybetreatedwith1mgepinephrinebyIVevery3–5minutesasneeded.Vasopressin40unitsbyIVevery3–5minutesmaybeusedinplaceofthefirstand/orseconddosesofepinephrine,butdoingsodoesnotenhanceoutcomes.Survivalratesinacardiacarrestpatientwithasystolearemuchlowerthanapatientwitharhythmamenabletodefibrillation;asystoleisitselfnota"shockable"rhythm.Out-of-hospitalsurvivalrates(evenwithemergencyintervention)arelessthan2percent.[4]CausePossibleunderlyingcausesincludetheHsandTs.[5][6][7]HypovolemiaHypoxiaHydrogenions(acidosis)HypothermiaHyperkalemiaorHypokalemiaHypoglycemiaTabletsorToxins(drugoverdose)ElectricshockTachycardiaCardiacTamponadeTensionpneumothoraxThrombosis(myocardialinfarctionorpulmonaryembolism)Trauma(hypovolemiafrombloodloss)Whiletheheartisasystolic,thereisnobloodflowtothebrainunlessCPRorinternalcardiacmassage(whenthechestisopenedandtheheartismanuallycompressed)isperformed,andeventhenitisasmallamount.Aftermanyemergencytreatmentshavebeenappliedbuttheheartisstillunresponsive,itistimetoconsiderpronouncingthepatientdead.Evenintherarecasethatarhythmreappears,ifasystolehaspersistedforfifteenminutesormore,thebrainwillhavebeendeprivedofoxygenlongenoughtocausebraindeath.ECGleadshowingasystole(flatline)AsystoleAsystolecoarseSeealsoAgonalheartrhythmCardiacarrestIctalasystoleMyocardialinfarctionVentricularfibrillationReferences1.Baldzizhar,A;Manuylova,E;Marchenko,R;Kryvalap,Y;Carey,MG(September2016)."VentricularTachycardias:CharacteristicsandManagement.".CriticalcarenursingclinicsofNorthAmerica.28(3):317–29.PMID27484660(https://www.ncbi.nlm.nih.gov/pubmed/27484660).doi:10.1016/j.cnc.2016.04.004(https://doi.org/10.1016%2Fj.cnc.2016.04.004).2.citejournal|last1=Kutsogiannis|first1=D|first2=J|title=Survivalafterin-ICUPEA/asystolecardiacarrestunchangedat20yrs|journal=CMAJ|date=October4,2011.|http://pulmccm.org/main/2011/review-articles/survival-after-in-icu-cardiac-arrest-poor/3.AHACardiacRecussitationGuidelines,2010:http://circ.ahajournals.org/cgi/content/full/122/18_suppl_3/S7294.http://journals.lww.com/surveyanesthesiology/Citation/2008/10000/Medical_Futility_in_Asystolic_Out_of_Hospital.44.aspx5.MazurG(2004).ACLS:PrinciplesAndPractice.Dallas:AmericanHeartAssn.pp.71–87.ISBN0-87493-341-2.6.BarnesTG,CumminsRO,FieldJ,HazinskiMF(2003).ACLSforexperiencedproviders.Dallas:AmericanHeartAssn.pp.3–5.ISBN0-87493-424-9.7.ECCCommittee,SubcommitteesandTaskForcesoftheAmericanHeartAssociation(Dec2005)."2005AmericanHeartAssociationGuidelinesforCardiopulmonaryResuscitationandEmergencyCardiovascularCare-Part7.2:ManagementofCardiacArrest."(http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-58).Circulation.112(24Suppl):IV1–203(7.2IV58–66).PMID16314375(https://www.ncbi.nlm.nih.gov/pubmed/16314375).doi:10.1161/CIRCULATIONAHA.105.166550(https://doi.org/10.1161%2FCIRCULATIONAHA.105.166550).Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Asystole&oldid=788142388"Categories:MedicalaspectsofdeathMedicalemergenciesCausesofdeathCardiacarrhythmiaThispagewaslasteditedon29June2017,at18:31.TextisavailableundertheCreativeCommonsAttribution-ShareAlikeLicense;additionaltermsmayapply.Byusingthissite,youagreetotheTermsofUseandPrivacyPolicy.Wikipedia®isaregisteredtrademarkoftheWikimediaFoundation,Inc.,anon-profitorganization.