Asystole Usually Occurs Secondary to Prolonged Ventricular Fibrillation (VF) or Pulseless Electrical Activity (PEA): in these cases, asystole results from the subsequent loss of electrical activity
Study of Outcome of Out-of-Hospital Cardiac Arrest Associated with Non-Shockable Rhythms (Circulation, 2012) [MEDLINE]
Outcome of Out-of-Hospital Cardiac Arrest Associated with Non-Shockable Rhythms is Generally Worse than that Associated with Shockable Rhythms
Outcome of Out-of-Hospital Cardiac Arrest Associated with Non-Shockable Rhythms Improved Significantly (Increased Probability of Return of Spontaneous Circulation, Improved 1 mo Survival, and Improved Favorable Neurologic Outcome) After Implementation of Resuscitation Guideline Changes Which Eliminated “Stacked” Shocks and Emphasized Chest Compressions
Recommendations
CPR Should Be Performed Per the Advanced Cardiac Life Support (ACLS) Guidelines (see Advanced Cardiac Life Support) (Circulation, 2015) [MEDLINE]
Japanese Study of the Prehospital Use of Epinephrine in Out-of-Hospital Cardiac Arrest (JAMA, 2012) [MEDLINE]
Prehospital Epinephrine Increased the Probability of Return of Spontaneous Circulation
However, Prehospital Epinephrine Decreased the Probability of Survival and Good Functional Outcome 1 mo After the Event
Recommendations
Epinephrine Should Be Used Per the Advanced Cardiac Life Support (ACLS) Guidelines (see Advanced Cardiac Life Support, [[Advanced Cardiac Life Support]]) (Circulation, 2015) [MEDLINE]
Agents without Clinical Efficacy in Pulseless Electrical Activity
Trial of Atropine + Epinephrine vs Epinephrine Alone in Out-of-Hospital Cardiac Arrest (Circ J, 2011) [MEDLINE]
Atropine Had No Long-Term (30 Day) Neurologic Benefit in Adults with Out-of-Hospital Cardiac Arrest Due to a Non-Shockable Rhythm (PEA, Asystole)
Atropine + Epinephrine Group Had Lower Survival Rate (3.2%) vs Epinephrine Alone Group (7.1%)
Recommendations
Although Atropine is Not Generally Recommended in PEA, it May Be Considered in Select Cases of PEA with Slow Heart Rate (<50 Beats/Min) or Relative Bradycardia (Heart Rate Lower than Expected Relative to the Underlying Condition)
Temporary Pacing
Clinical Efficacy
Trial of Prehospital Transcutaneous Pacing in Out-of-Hospital Cardiac Arrest (Circulation, 1987) [MEDLINE]
Prehospital Transcutaneous Pacing in Out-of-Hospital Cardiac Arrest Did Not Improve Outcome
Trial of Prehospital Transcutaneous Pacing in Out-of-Hospital Cardiac Arrest (Ann Emerg Med, 1988) [MEDLINE]
Prehospital Transcutaneous Pacing in Out-of-Hospital Cardiac Arrest Did Not Improve Outcome
Trial of Prehospital Transcutaneous Pacing in Out-of-Hospital Cardiac Arrest (Ann Emerg Med, 1992) [MEDLINE]
Prehospital Transcutaneous Pacing in Out-of-Hospital Cardiac Arrest Did Not Improve Survival
Trial of Prehospital Transcutaneous Pacing in Out-of-Hospital Cardiac Arrest (NEJM, 1993) [MEDLINE]
Prehospital Transcutaneous Pacing in Out-of-Hospital Cardiac Arrest Did Not Improve Outcome, Even When Performed Early by EMT’s in the Field
Recommendations
Transcutaneous Pacing is Not Recommended in Asystolic Arrest Per the Advanced Cardiac Life Support (ACLS) Guidelines (see Advanced Cardiac Life Support) (Circulation, 2015) [MEDLINE]
References
Prehospital trial of emergency transcutaneous cardiac pacing. Circulation. 1987;76(6):1337 [MEDLINE]
Prehospital external cardiac pacing: a prospective, controlled clinical trial. Ann Emerg Med. 1988;17(11):1221 [MEDLINE]
Transcutaneous cardiac pacing in the treatment of out-of-hospital pediatric cardiac arrests. Ann Emerg Med. 1992 Aug;21(8):905-9 [MEDLINE]
Out-of-hospital transcutaneous pacing by emergency medical technicians in patients with asystolic cardiac arrest. N Engl J Med. 1993;328(19):1377 [MEDLINE]
Atropine sulfate for patients with out-of-hospital cardiac arrest due to asystole and pulseless electrical activity. Circ J. 2011;75(3):580 [MEDLINE]
Impact of changes in resuscitation practice on survival and neurological outcome after out-of-hospital cardiac arrest resulting from nonshockable arrhythmias. Circulation. 2012;125(14):1787 [MEDLINE]
Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA. 2012 Mar;307(11):1161-8 [MEDLINE]
Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 Suppl 2):S444-64. doi: 10.1161/CIR.0000000000000261 [MEDLINE]
