Asystole Algorithm

Asystole and Its Treatment in ACLS

Asystole is defined as a cardiac arrest rhythm in which there is no discernible electrical activity on the ECG monitor. Asystole is sometimes referred to as a “flat line.” Confirmation that a “flat line” is truly asystole is an important step in the ACLS protocol.

Ensure that asystole is not another rhythm that looks like a “flat line.” Fine VF can appear to be asystole, and a “flat line” on a monitor can be due to operator error or equipment failure

The following are common causes of an isoelectric line that is not asystole: 1. loose or disconnected leads; 2. loss of power to the ECG monitor; 3. low signal gain on the ECG monitor.

Asystole for many patients is the result of a prolonged illness or cardiac arrest, and prognosis is very poor. Few patients will likely have a positive outcome and successful treatment of cardiac arrest with asystole will usually involve identification and correction of an underlying cause of the asystole.

The H’s and T’s of ACLS should be reviewed to identify any underlying cause that could have precipitated the asystole.

Some of the most common reasons to stop or withhold resuscitative efforts are:

• DNR status
• Threat to the safety of rescuers
• Family or personal information such as a living will or advanced directive
• Rigor mortis

To learn more about asystole and watch a short video showing asystole and fine VF on a monitor: