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Asystole is a topic covered in the 5-Minute Emergency Consult.

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Absence of ventricular electrical activity


  • An end-stage rhythm, sometimes degrading from:
    • Prolonged bradycardia
    • Prolonged ventricular fibrillation (VF)
    • Prolonged pulseless electrical activity
  • Patient is extremely unlikely to survive when asystole occurs outside the hospital:
    • ∼40% will have return of spontaneous circulation and survive to hospital admission, but <15% survive to hospital discharge.
  • Prognosis is similarly poor for those patients who develop asystole after countershock for ventricular tachycardia/VF; <10% survive to hospital discharge.
  • Potentially reversible causes include:
    • Hypoxia
    • Hypovolemia (blood loss)
    • Acidosis
    • Hyperkalemia
    • Hypokalemia
    • Drug overdose
    • Hypothermia
    • Pulmonary embolism
    • Myocardial infarction
    • Tension pneumothorax
    • Cardiac tamponade

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Rosen, Peter, et al., editors. "Asystole." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307503/all/Asystole.
Asystole. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307503/all/Asystole. Accessed April 23, 2019.
Asystole. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307503/all/Asystole
Asystole [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307503/all/Asystole.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Asystole ID - 307503 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307503/all/Asystole PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -