Use of atropine for brady-asystolic prehospital cardiac arrest

The efficacy of atropine in treating prehospital cardiac arrest patients developing asystole or slow pulseless idioventricular rhythms (PIVR) was evaluated in a controlled, prospective study. Twenty-one prehospital cardiac-arrested patients developing asystole or PIVR (less than 40) were divided into atropine-treated or non-atropine (control) groups. Control group patients received treatment including bicarbonate, epinephrine, calcium, isoproterenol, dexamethasone, and transthoracic pacing. Atropine-treated patients received 1 mg atropine intravenously with a repeat dose at one minute if no rhythm change occurred. These patients then received the same therapy as the control group. In both groups, rhythm changes were treated as appropriate for the specific circumstances. No differences in mortality or effected rhythm changes were observed. Ten of the 11 controls and eight of 10 atropine patients developed rhythms other than asystole or PIVR less than 40. However, only two patients in each group were successfully resuscitated in the emergency department and only one control group patient was discharged alive. Our findings are not in agreement with those of previous authors who have advocated the use of atropine in cardiac arrest patients with these arrhythmias. We question the usefulness of atropine in this setting. More study is necessary in order to clearly define its role in the resuscitation of patients who have sustained brady-asystolic arrests.