Atropine sulfate for patients with out-of-hospital cardiac arrest due to asystole and pulseless electrical activity

Ken Nagao, Tsukasa Yagi, Tetsuya Sakamoto, Kazuhide Koseki, Masaki Igarashi, Shinichi Ishimatsu, Akira Sato, Shingo Hori, Shigeru Kanesaka, Yuichi Hamabe, Daizo Saito, Shinya Kitamura

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: The 2005 guidelines for cardiopulmonary resuscitation (CPR) have recommended that administration of atropine can be considered for non-shockable rhythm, but there are insufficient data in humans. Methods and Results: The effects of atropine were assessed in 7,448 adults with non-shockable rhythm from the SOS-KANTO study. The primary endpoint was a 30-day favorable neurological outcome after cardiac arrest. In the 6,419 adults with asystole, the epinephrine with atropine group (n=1,378) had a significantly higher return of spontaneous circulation (ROSC) rate than the epinephrine alone group (n=5,048) with an adjusted odds ratio of 1.6 (95% confidence interval (CI) 1.4-1.7, P<0.0001), but the 2 groups had similar 30-day favorable neurological outcome with an adjusted odds ratio of 0.6 (95%CI 0.2-1.7; P=0.37). In the 1,029 adults with pulseless electrical activity (PEA), the 2 groups had similar rates of ROSC and 30-day favorable neurological outcome, and the epinephrine with atropine group had a significantly lower 30-day survival rate than the epinephrine alone group with an adjusted odds ratio of 0.4 (95%CI 0.2-0.9, P=0.016). Conclusions: Administration of atropine had no long-term neurological benefit in adults with out-of-hospital cardiac arrest due to non-shockable rhythm. Atropine is not useful for adults with PEA.

Original languageEnglish
Pages (from-to)580-588
Number of pages9
JournalCirculation Journal
Volume75
Issue number3
DOIs
Publication statusPublished - 2011

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Out-of-Hospital Cardiac Arrest
Heart Arrest
Atropine
Epinephrine
Odds Ratio
Confidence Intervals
Cardiopulmonary Resuscitation
Survival Rate
Guidelines

Keywords

  • Asystole
  • Atropine
  • Cardiac arrest
  • Neurological outcome
  • Pulseless electrical activity (PEA)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Nagao, K., Yagi, T., Sakamoto, T., Koseki, K., Igarashi, M., Ishimatsu, S., ... Kitamura, S. (2011). Atropine sulfate for patients with out-of-hospital cardiac arrest due to asystole and pulseless electrical activity. Circulation Journal, 75(3), 580-588. https://doi.org/10.1253/circj.CJ-10-0485

Atropine sulfate for patients with out-of-hospital cardiac arrest due to asystole and pulseless electrical activity. / Nagao, Ken; Yagi, Tsukasa; Sakamoto, Tetsuya; Koseki, Kazuhide; Igarashi, Masaki; Ishimatsu, Shinichi; Sato, Akira; Hori, Shingo; Kanesaka, Shigeru; Hamabe, Yuichi; Saito, Daizo; Kitamura, Shinya.

In: Circulation Journal, Vol. 75, No. 3, 2011, p. 580-588.

Research output: Contribution to journalArticle

Nagao, K, Yagi, T, Sakamoto, T, Koseki, K, Igarashi, M, Ishimatsu, S, Sato, A, Hori, S, Kanesaka, S, Hamabe, Y, Saito, D & Kitamura, S 2011, 'Atropine sulfate for patients with out-of-hospital cardiac arrest due to asystole and pulseless electrical activity', Circulation Journal, vol. 75, no. 3, pp. 580-588. https://doi.org/10.1253/circj.CJ-10-0485
Nagao, Ken ; Yagi, Tsukasa ; Sakamoto, Tetsuya ; Koseki, Kazuhide ; Igarashi, Masaki ; Ishimatsu, Shinichi ; Sato, Akira ; Hori, Shingo ; Kanesaka, Shigeru ; Hamabe, Yuichi ; Saito, Daizo ; Kitamura, Shinya. / Atropine sulfate for patients with out-of-hospital cardiac arrest due to asystole and pulseless electrical activity. In: Circulation Journal. 2011 ; Vol. 75, No. 3. pp. 580-588.
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abstract = "Background: The 2005 guidelines for cardiopulmonary resuscitation (CPR) have recommended that administration of atropine can be considered for non-shockable rhythm, but there are insufficient data in humans. Methods and Results: The effects of atropine were assessed in 7,448 adults with non-shockable rhythm from the SOS-KANTO study. The primary endpoint was a 30-day favorable neurological outcome after cardiac arrest. In the 6,419 adults with asystole, the epinephrine with atropine group (n=1,378) had a significantly higher return of spontaneous circulation (ROSC) rate than the epinephrine alone group (n=5,048) with an adjusted odds ratio of 1.6 (95{\%} confidence interval (CI) 1.4-1.7, P<0.0001), but the 2 groups had similar 30-day favorable neurological outcome with an adjusted odds ratio of 0.6 (95{\%}CI 0.2-1.7; P=0.37). In the 1,029 adults with pulseless electrical activity (PEA), the 2 groups had similar rates of ROSC and 30-day favorable neurological outcome, and the epinephrine with atropine group had a significantly lower 30-day survival rate than the epinephrine alone group with an adjusted odds ratio of 0.4 (95{\%}CI 0.2-0.9, P=0.016). Conclusions: Administration of atropine had no long-term neurological benefit in adults with out-of-hospital cardiac arrest due to non-shockable rhythm. Atropine is not useful for adults with PEA.",
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AU - Nagao, Ken

AU - Yagi, Tsukasa

AU - Sakamoto, Tetsuya

AU - Koseki, Kazuhide

AU - Igarashi, Masaki

AU - Ishimatsu, Shinichi

AU - Sato, Akira

AU - Hori, Shingo

AU - Kanesaka, Shigeru

AU - Hamabe, Yuichi

AU - Saito, Daizo

AU - Kitamura, Shinya

PY - 2011

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N2 - Background: The 2005 guidelines for cardiopulmonary resuscitation (CPR) have recommended that administration of atropine can be considered for non-shockable rhythm, but there are insufficient data in humans. Methods and Results: The effects of atropine were assessed in 7,448 adults with non-shockable rhythm from the SOS-KANTO study. The primary endpoint was a 30-day favorable neurological outcome after cardiac arrest. In the 6,419 adults with asystole, the epinephrine with atropine group (n=1,378) had a significantly higher return of spontaneous circulation (ROSC) rate than the epinephrine alone group (n=5,048) with an adjusted odds ratio of 1.6 (95% confidence interval (CI) 1.4-1.7, P<0.0001), but the 2 groups had similar 30-day favorable neurological outcome with an adjusted odds ratio of 0.6 (95%CI 0.2-1.7; P=0.37). In the 1,029 adults with pulseless electrical activity (PEA), the 2 groups had similar rates of ROSC and 30-day favorable neurological outcome, and the epinephrine with atropine group had a significantly lower 30-day survival rate than the epinephrine alone group with an adjusted odds ratio of 0.4 (95%CI 0.2-0.9, P=0.016). Conclusions: Administration of atropine had no long-term neurological benefit in adults with out-of-hospital cardiac arrest due to non-shockable rhythm. Atropine is not useful for adults with PEA.

AB - Background: The 2005 guidelines for cardiopulmonary resuscitation (CPR) have recommended that administration of atropine can be considered for non-shockable rhythm, but there are insufficient data in humans. Methods and Results: The effects of atropine were assessed in 7,448 adults with non-shockable rhythm from the SOS-KANTO study. The primary endpoint was a 30-day favorable neurological outcome after cardiac arrest. In the 6,419 adults with asystole, the epinephrine with atropine group (n=1,378) had a significantly higher return of spontaneous circulation (ROSC) rate than the epinephrine alone group (n=5,048) with an adjusted odds ratio of 1.6 (95% confidence interval (CI) 1.4-1.7, P<0.0001), but the 2 groups had similar 30-day favorable neurological outcome with an adjusted odds ratio of 0.6 (95%CI 0.2-1.7; P=0.37). In the 1,029 adults with pulseless electrical activity (PEA), the 2 groups had similar rates of ROSC and 30-day favorable neurological outcome, and the epinephrine with atropine group had a significantly lower 30-day survival rate than the epinephrine alone group with an adjusted odds ratio of 0.4 (95%CI 0.2-0.9, P=0.016). Conclusions: Administration of atropine had no long-term neurological benefit in adults with out-of-hospital cardiac arrest due to non-shockable rhythm. Atropine is not useful for adults with PEA.

KW - Asystole

KW - Atropine

KW - Cardiac arrest

KW - Neurological outcome

KW - Pulseless electrical activity (PEA)

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