Cardiac flatline Successful resuscitation is generally unlikely and is inversely related to the length of time spent attempting resuscitation. Defibrillation, which can be used for other causes of cardiac arrests, is not recommended, despite commonly appearing on medical dramas as a remedy for asystole.
New research finds that it's fairly common for the heart to restart — usually just for a beat or two — after a person initially flatlines. No one in the study, which took place in intensive care units (ICUs) in three countries, survived or even regained consciousness.
We found that human heart activity often stops and restarts a number of times during a normal dying process. Out of 480 “flatline” signals reviewed, we found a stop-and-start pattern in 67 (14 per cent). The longest that the heart stopped before restarting on its own was four minutes and 20 seconds.
The only effective treatment is to deliver an electrical shock using a device called a defibrillator (to de-fibrillate the heart), which stops the chaotic rhythm of a heart in VF, giving it the chance to restart beating with a normal rhythm.
Cardiopulmonary resuscitation (CPR) will not restart a heart in sudden cardiac arrest. CPR is just a temporary measure used to continue a minimal supply of oxygen to the brain and other organs. When someone is in sudden cardiac arrest, defibrillation is the only way to re-establish a regular heartbeat.
When a patient displays a cardiac flatline, the treatment of choice is cardiopulmonary resuscitation and injection of vasopressin (epinephrine and atropine are also possibilities). Successful resuscitation is generally unlikely and is inversely related to the length of time spent attempting resuscitation.
The longest that the heart stopped before restarting on its own was four minutes and 20 seconds. The longest time that heart activity continued after restarting was 27 minutes, but most restarts lasted just one to two seconds.
Procedure. In a precordial thump, a provider strikes at the middle of a person's sternum with the ulnar aspect of the fist. The intent is to interrupt a potentially life-threatening rhythm. The thump is thought to produce an electrical depolarization of 2 to 5 joules.
Possible Causes
Blood loss. Low oxygen levels. Electrolyte problems or dehydration. Heart attack.
Overall the prognosis is poor, and the survival is even poorer if there is asystole after resuscitation. Data indicate that less than 2% of people with asystole survive. Recent studies do document improved outcomes, but many continue to have residual neurological deficits.
Normally there is no measurable, meaningful brain activity after the heart stops beating. Within two to 20 seconds the brain “flatlines.”
Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 to 6 minutes later.
"In this case, consciousness and awareness appeared to occur during a three-minute period when there was no heartbeat. "This is paradoxical, since the brain typically ceases functioning within 20-30 seconds of the heart stopping and doesn't resume again until the heart has been restarted.
To help the heart to return to it's normal rhythm, you can use a defibrillator on a person as many times as needed.
If the heart suddenly stops, defibrillators can also help it beat again. Different types of defibrillators work in different ways. Automated external defibrillators (AEDs), which are now found in many public spaces, are used to save the lives of people experiencing cardiac arrest.
Non-Shockable Rhythms
An Asystole — rhythm means that the heart's electrical system has shut down and there is no heartbeat. Asystole can be the result of untreated VT or VF. If someone experiences Asystole, CPR should be initiated immediately to provide the best chances of survival.
Asystole (ay-sis-stuh-lee) is when there's no electricity or movement in your heart. That means you don't have a heartbeat. It's also known as flatline. That's because doctors check the rhythm of your heart with a machine called an electrocardiogram -- also called an ECG or EKG.
Rhythms that are not amenable to shock include pulseless electrical activity (PEA) and asystole. In these cases, identifying primary causation, performing good CPR, and administering epinephrine are the only tools you have to resuscitate the patient.
Proper steps for performing CPR and using an AED on women
Remove all clothing from the patient's chest – this includes swimsuits, bras, sports bras, tank tops, and regular tops. If you need to, you can cut through clothing with the shears included in an AED's response kit. Be sure to cut away from the person's face.
In addition to a reduced chance of survival, improperly-administered CPR can also result in: Broken or cracked ribs and/or sternum fractures caused by improperly-administered chest compressions (this is a particular danger for children and the elderly); Pressure buildup in the body due to too many chest compressions.
NO adverse effects have been reported. Based on the available evidence, it appears that the fear of doing harm by giving chest compressions to some who has no signs of life, but has a beating heart, is unfounded.
In time, the heart stops and they stop breathing. Within a few minutes, their brain stops functioning entirely and their skin starts to cool. At this point, they have died.
If asystole persists for fifteen minutes or more, the brain will have been deprived of oxygen long enough to cause brain death. Death often occurs.
A 65-year-old man in Malaysia regained vital signs two-and-a-half hours after doctors at Seberang Jaya Hospital, Penang, pronounced him dead. He died three weeks later.
Refer to the deceased by name. If requested, explain the cause of death in non-medical terms. Allow time for questions; be open to acknowledging that there may be things you don't know. Offer assurance that everything possible was done to keep the patient comfortable.