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

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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.

Original languageEnglish
Pages (from-to)580-588
Number of pages9
JournalCirculation Journal
Volume75
Issue number3
DOIs
Publication statusPublished - 2011 Mar 11

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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., 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, 75(3), 580-588. https://doi.org/10.1253/circj.CJ-10-0485