ACLS Cases – Asystole and Pulseless Electrical Activity

In cardiac arrest, asystole and pulseless electrical activity are considered “shockable” rhythms. This means that an unsynchronized defibrillation or shock energy from an AED or manual defibrillator CANNOT be used to restore a normal cardiac electrical rhythm. Instead, drugs must be given.

Asystole
Lack of cardiac electrical activity
ECG monitor demonstrates “flat line”

Pulseless Electrical Activity (PEA)
Any organized rhythm without a pulse, excludes VTach, VFib

Drugs used to Treat Asystole/PEA 

• Epinephrine administration: 1 mg IV/IO every 3-5 minutes
• Vasopressin is no longer recommended
  • Vasopressin does not offer an advantage over epinephrine
  • The combined use of epinephrine and vasopressin is no better than epinephrine alone
  • Vasopressin was eliminated from the algorithm for simplicity
• Do not stop CPR to administer drugs
• Search for, identify, and treat reversible causes (H’s and T’s)