ACLS — Asystole
Flatline rhythm — confirm and treat aggressively while searching for reversible causes
Overview
- Flatline rhythm — confirm and treat aggressively while searching for reversible causes
Protocol steps
- id: 1; title: Confirm True Asystole; detail: Check leads are attached. Increase gain. Check in 2 leads. Rule out fine VF. Confirm no pulse.; time: ; drugs:
- id: 2; title: CPR Immediately; detail: Start high-quality CPR. Rate 100-120/min, depth 2-2.4 inches, full recoil. Establish IV/IO access.; time: 120; drugs:
- id: 3; title: Epinephrine ASAP; detail: Give epinephrine as soon as IV/IO established. Repeat every 3-5 minutes.; time: ; drugs: name: Epinephrine; dose: 1mg IV/IO; interval: q3-5min
- id: 4; title: Search for Reversible Causes; detail: Aggressively search H's and T's. Bedside echo may reveal tamponade, PE, or hypovolemia. Check glucose, potassium, temperature.; time: ; drugs:
- id: 5; title: Rhythm Check Every 2 Minutes; detail: Brief rhythm check. Any organized activity? Treat accordingly. Shockable? Switch to VF/VT protocol.; time: 120; drugs: ; branch: true
- id: 6; title: Consider Termination; detail: If no ROSC after adequate trial (typically 20+ min), consider termination of efforts. Factors: witnessed arrest, initial rhythm, bystander CPR, time to EMS, comorbidities.; time: ; drugs:
Source and review
- AHA ACLS Guidelines 2020; Panchal et al., Circulation 2020. Last reviewed: 2024-11-01