I did not see this movie.
I wonder if some of the confusion is around whether or not the term “flatline” is being used for asystole.
Perhaps, as someone whose career was spent occasionally resuscitating the nearly dead, I can comment.
In a normothermic heart, asystole means all of the natural pacemaking cells have ceased to function. There are an assortment of these, all the way from the sinus node to the ventricle itself. In a typical cardiac arrest, eventually these cells become ischemic enough to stop their depolarizing/repolarizing cycles, and there is no electrical activity. That patient is “flatline” because the cardiac monitor shows no electrical activity at all. Using a countershock on such a patient will not generate a heartbeat. Treatment for asystole includes various drugs and/or pacemakers, and in the setting of a typical cardiac arrest is not usually effective, either.
If the heart has been chilled (as it is for many cardiac surgeries, for example) it may regain a natural heartbeat on its own as it is warmed up and the pacemaking cells begin to function again. It may also simply recover to a chaotic and disorganized rhythm called ventricular fibrillation. This electrical activity is too disorganized to sustain a cardiac output. A countershock in that instance will reset all of the cells at once by depolarizing all of them, so the natural pacemaker cells (or an artificial pacemaker) can then re-establish normal function.
There are a variety of abnormal rhythms treated with emergent or elective countershocks; sometimes these shocks are synchronized to the pathologic rhythm since a shock at the wrong time in the natural cycle can precipitate abnormal rhythms, including ventricular fibrillation.
During an actual resuscitation, a pulseless patient with a “flatline” monitor is often countershocked on the assumption that one cannot rule out fine ventricular fibrillation with absolute certainty, and there’s not much to lose since asystole is almost uniformly fatal. Ventricular fibrillation is the commonest lethal treatable rhythm for a typical cardiac arrest. Fine v fib creates tiny squiggles on the monitor, and the monitor in real life is never so perfectly flatline as it is on TV. Leads attached to a patient pick up any tiny amount of activity, whether from the heart or not. You don’t get a literal “flat” line.
I don’t know if it’s a popular misconception that defibrillators can help asystole, but it is correct that a countershock is of no value in true asystole. Countershocks work by depolarizing all cells at once. This is followed by a period of electrical silence as the cells recover, and at the end of that standstill, the idea is that the natural pacemaker cells start their cycle first (as they are supposed to) and can then trigger the natural process of spreading depolarization to the cardiac muscle through the conduction system of the heart.
Hope that’s clear as mud. Perhaps I should have just said we sometimes shock pulseless asystole in case it’s fine v fib. In a chilled heart warming up, a shock for v fib re-establishes a normal rhythm.
