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Asystole Classification and external resources
ECG lead showing Asystole (Flatline)
ICD-10	I46.0
ICD-9	427.5

In medicine, asystole (colloquially known as flatline) is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. Asystole is one of the conditions required for a medical practitioner to certify death.

When a patient displays asystole, the treatment of choice is an injection of vasopressin (epinephrine and atropine may also be used) ^[1] and chest compressions. In asystole, the heart will not respond to defibrillation because it is already depolarized, however some emergency physicians advocate a trial of defibrillation in case the rhythm is actually fine ventricular fibrillation, although little evidence exists to support the practice. Asystole is usually a confirmation of death as opposed to a heart rhythm to be treated, although a small minority of patients are successfully resuscitated, if the underlying cause is identified and treated immediately.

Possible underlying causes include the Hs and Ts.^[2][3][4]

• Hypovolemia
• Hypoxia
• Hydrogen ions (Acidosis)
• Hypothermia
• Hyperkalemia or Hypokalemia
• Hypoglycemia
• Tablets or Toxins (Drug overdose)
• Cardiac Tamponade
• Tension pneumothorax
• Thrombosis (Myocardial infarction)
• Thrombosis (Pulmonary embolism)
• Trauma (Hypovolemia from blood loss)

While the heart is asystolic, there is no blood flow to the brain unless CPR or internal cardiac massage (when the chest is opened and the heart is manually compressed) is performed, and even then, it is still a small amount. After many emergency treatments have been applied but the heart is still unresponsive, it is time to consider pronouncing the patient dead. Even in the rare case that a rhythm should reappear, if asystole has persisted for fifteen minutes or more the brain will have been deprived of oxygen long enough to cause brain death.

See also

• Cardiac arrest
• Myocardial infarction
• Ventricular fibrillation

References

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