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]
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)
References
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]