When people think of the word “flatline”, they immediately visualise a medical crisis where a patient is lying unconscious, with doctors and nurses shouting out medical terminology while administering drugs, all to the suspenseful music and apathetic monotone and single horizontal line on the ECG machine. The doctor then shouts “Clear!” and proceeds to shock the patient with two paddles. This is repeated until some structures appear on the ECG, symbolising that the crisis has been resolved.
Of course this is a scene from a typical medical drama. Television shows, especially medical ones, are notorious for sacrificing medical accuracy for the sake of drama and tension. The “flatline” is the most cliché, repeated mistake made by almost every medical television show ever made.
The proper terminology for a flatline (a colloquial term), is asystole. This means that there is no systole, or contraction of the heart. An ECG (electrocardiogram) measures electrical signals in the heart, and in asystole there is insignificant amounts of electric activity, and the classic QRS complex is not seen. In this state, the heart is not pumping any blood and is electrically silent, meaning that the patient is clinically dead.
When asked how to treat this condition, the majority of people (even medical students) will shout “Shock!” or “Defibrillate!”. Defibrillation is the administering of an electrical shock to try “reboot” the heart, and correct the fibrillation – the chaotic electrical signal interfering with the normal, rhythmic electrical activity. Unfortunately, this is completely wrong yet so often depicted on television and films.
As asystole is a state of no electrical activity, there is no fibrillation to remove, nor is there anything to reset. Defibrillation in this state may even cause harm, causing tissue damage and lowering the chance of survival.
The correct treatment is injecting adrenaline (epinephrine in the U.S.A, atropine may be administered also) and CPR. Unfortunately, asystole is a condition that cannot be reversed, unless the heart somehow restores its own electrical activity. CPR merely keeps the patient’s perfusion going to preserve the organs for a longer time. Ergo, asystole signifies certain death, especially after 5 minutes where the heart will not respond to any drugs or electric shocks. In fact, asystole is one of the conditions required for the certification of a patient’s death.
Another related example of a (potentially fatal) misrepresentation of medicine in the media is the adrenaline injection. As mentioned before, this is the treatment for asystole. However, it is administered intravenously (into a vein) and never directly into the heart as in Pulp Fiction. This is more likely to kill the patient than save them, as the heart muscles could be damaged and delicate coronary arteries may become ruptured.
So why is it that the media continues to depict such blatant errors, that set a “common sense” that affect even medical professionals? This is most likely due to the audience wanting to see a dramatic scene, in a gripping life-or-death situation with drastic, powerful action. For example, the audience would much rather see the use of paddles or a giant needle being stabbed into the patient than seeing continuous CPR with no showy movements.
The next time you watch a medical television show, count how many times the doctors try to defibrillate a flatline.
