Cardiac arrest: no clear benefit from atropine.

Clinical bottom line (level 2b-)

  1. Patients in brady-asystolic cardiac arrest who received atropine were not clearly more likely to have a change in rhythm, regain a palpable pulse or be discharged from hospital.
Coon et al: Annals of Emergency Medicine 1981; 10 (9): 462-467
Expires December 2003

The study

Unblinded ?concealed quasi-randomised trial with intention-to-treat
Setting: pre-hospital care, county, USA

21 patients (aged range 16 to 82 years; mean 63, ?q% male) in complete cardiopulmonary arrest with asystole or slow pulseless idioventricular rhythm <40 beats/ min

Excluded if
  • history or physical examination inconsistent with primary cardiac aetiology for arrest
  • corrected pH not between 7.2 and 7.55m pO 2 <75 mmHg
  • sodium not between 125 and 158 mmol/l; potassium not between 2.2 and 5.8 mmol/l
  • Hb <10 g/ dl and abnormal PT or aPTT


    • Control Group: (n = 11, 11 analysed): calcium, dexamethasone isoproterenol
    Experimental Group: (n = 10, 10 analysed): atropine 1 mg iv initially, and further 1 mg if required, followed by calcium, dexamethasone, isoproterenol
    All patients received CPR, had oesophageal obturator airways inserted and received positive pressure ventilation with oxygen. Patients had a 50 mmol sodium bicarbonate iv, and were allowed countershock, lidocaine, epinephrine and further bicarbonate if necessary.
    100% followed for ?

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no change in rhythm unknown 1
    (9.09%)    		 2
    (20.0%)    		 -120%
    (-1972% to 77%)    		 -10.9%
    (-41.0% to 19.2%)    		 -9
    (NNT = 5 to infinity;
    NNH = 2 to infinity)
    no resumption of palpable pulse unknown 5
    (45.5%)    		 6
    (60.0%)    		 -32%
    (-200% to 42%)    		 -14.6%
    (-56.8% to 27.7%)    		 -7
    (NNT = 4 to infinity;
    NNH = 2 to infinity)
    admission to hospital unknown 2
    (18.2%)    		 2
    (20.0%)    		 -10%
    (-541% to 81%)    		 -1.82%
    (-35.5% to 31.9%)    		 -55
    (NNT = 3 to infinity;
    NNH = 3 to infinity)
    not discharged from hospital unknown 10
    (90.9%)    		 10
    (100%)    		 -10%
    (-33% to 9%)    		 -9.09%
    (-26.1% to 7.90%)    		 -11
    (NNT = 13 to infinity;
    NNH = 4 to infinity)

    Comments

    1. Patients were alternately allocated to either treatment arm.
    2. The study is not large enough to show any effect from giving atropine.

    Citation

    1. Coon GA, Clinton JE, Ruiz E: Use of atropine for brady-asystolic prehospital cardiac arrest. Annals of Emergency Medicine 1981; 10 (9): 462-467
    Contributor: Euan Ashley and Chris Ball, December 2000
    Reviewer:

    Clinical Question.
    Patient cardiac arrest
    Intervention or Exposure atropine
    Comparison calcium, dexamethasone, isoproterenol
    Outcome change in rhythm