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Asystole, Emergency Medicine

David F. M. Brown and Calvin A. Lee Reviewed 06/2017



Absence of ventricular electrical activity 


  • An end-stage rhythm, sometimes degrading from:

    • Prolonged bradycardia

    • Prolonged ventricular fibrillation (VF)

    • Prolonged pulseless elect...


Signs and Symptoms

  • Unresponsive patient

  • Pulseless

  • Agonal or absence of spontaneous respirations

Essential Workup

  • Confirm asystole in 2 limb leads to exclude VF.

  • Confirm lead and cable connections.

  • ...



  • No intervention should be made for a patient with a valid Do Not Resuscitate document.

  • No intervention if patient can be verified as dead:

    • Rigor mortis

    • Dependent livedo

    • Injury incomp...



Admission Criteria

All patients with return of spontaneous circulation 

Discharge Criteria

None—all patients with return of spontaneous circulation need admission to an ICU for post-...

Pearls and Pitfalls

  • Emphasis on high-quality, minimally uninterrupted chest compressions while considering reversible causes of asystole

  • Resuscitation is likely to be successful only if reversible caus...

Additional Reading

  • Aufderheide  TP, Sigurdsson  G, Pirrallo  RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation.  2004;109:1960–1965.

  • Bernard  SA, Gr...



427.5 Cardiac arrest 


  • I46.2 Cardiac arrest due to underlying cardiac condition

  • I46.8 Cardiac arrest due to other underlying condition

  • I46.9 Cardiac arrest, cause unspecified

  • I46 Cardiac arr...

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