Immediate countershock treatment of asystole

While rapid intervention with basic cardiac life support and prompt delivery of prehospital care using advanced cardiac life support (ACLS) have yielded impressive results in the resuscitation of other arrest rhythms, very little improvement has been shown in the rates of resuscitation from asystole. Anecdotal reports list instances in which patients in asystole have had normal cardiac activity restored after defibrillation. Current ACLS protocols for initial evaluation recommend a single-lead "quick-look" interpretation of cardiac rhythm using portable defibrillator paddles. Under these conditions, ventricular fibrillation could masquerade as, or be misinterpreted as, asystole. We report preliminary field results in a medically controlled paramedic system using "quick-look" interpretation and immediate defibrillation of "asystole" by well-trained paramedics. Following initial countershock, standard ACLS protocols for asystole were used. For an eight-month period 119 patients were entered into the study and compared to system controls of asystolic patients presenting in the previous year. While ten patients (8.4%) showed an immediate rhythm change after initial countershock and six of ten reached the hospital with a rhythm and a pulse, no statistically significant comparison could be made regarding improved resuscitation or survival rates. The finding of no statistically significant deterioration of resuscitation or survival rates, however, justifies the continuation of the study.