Perform CPR

Check equipment, cables, electrodes,

Check gain

Confirm asystole in more then 1 lead




Secure airway

Establish IV or IO with NS or LR



Vasopressor of Choice

given during CPR

Epinephrine 1.0 mg


Vasopressin 40 U x1

instead of 1st or 2nd epi dose

then revert to epinephrine Q 3-5 min


Atropine 1.0mg

given during CPR

repeat q 3-5 min

to max total dose 3 mg




Evaluate for and treat reversible causes anytime during the sequence

Hypoxia                                   Toxins (overdose)

Hypovolemia                            Thromboemboli pulmonary

Hyper/Hypokalemia                 Thromboemboli coronary

Hydrogen ion (acidosis)            Trauma           

Hypoglycemia                          Tension pneumothorax 

                     Hypothermia                              Tamponade (cardiac)


If PT remains in asystole or other agonal

rhythms after successful airway control and

initial medications and no reversible causes are

identified, consider termination of resuscitative efforts.