Use of atropine in cardiac arrest

[RomeViking09]

Has anyone had any success with use of Atropine in a bradycardic PEA, I was wondering why remove a drug that speeds up the heart that is too slow (to the point of no pulse). I am not talking about asystolic arrest but those with electrical activity but no pulse. My view is that Epi may not work is cases of beta blockers (as Epi speeds up the heart with Beta-1) and the possibility of arrest that can be reversed by improving the rate to gain perfusion in non-trauma arrest.

[DwayneEMTP]

I think you're confusing PEA and bradycardic hypoperfusion.

PEA is independent of rate. It means that although your monitor may show absolutely normal electrical activity that the electrical activity is not being turned mechanical muscular activity. For some reason though the electrical current is telling the cardiac muscle to do it's thing the heart is unable to comply. There are quite a few reasons for this. In this pt if I had a dial tied directly to the pts electrical conduction system I could drop it to 10bpm, or crank it up to 300bpm and it would have zero effect on the physiological status of this pt.

Bradycardic hypoperfusion means that the heart is simply not beating fast enough to exchange gasses at a sufficient rate to maintain life for long. Speeding up the heart in this instance either chemically or electrically (pacing) can have very significant benefits for the pt.

See what I mean?

Dwayne

[P_Instructor]

One must understand the basic aspect of what Atropine is....a parasypathetic blocker. It's properties do not actually speed up the heart rate, but blocks a parasympathetic response which create the myocardium to revert back to it's intrinsic rate values (approx. 60 sinus/atrial and approx. 40 ventricular) in cases of bradycardia due to a parasympathetic response. Atropine used in bradycardic PEA is only an attempt to block the receptors that relay a parasympathetic response if it is there. Usually this is very rare...if at all. It is also why atropine is not routinely used in a slow rate high degree AV Block as this is not what the problem is. Atropine was a staple years ago in cardiac arrest after Epinephrine, however it's effacy did not warrent further use, and now it seems the same for bradycardic PEA.

[crotchitymedic1986]

Its all a joke, the only thing that saves cardiac arrest patients is immediate CPR and defibrillation. Until we start doing our jobs and educating the community to CPR and have the vehicles to deliver a defibrillator in 4 minutes or less, we are wasting our time. Pour the whole drug box in them everytime, you still will have less than 10% that walk out of the hospital.

[zippyRN]

Its all a joke, the only thing that saves cardiac arrest patients is immediate CPR and defibrillation. Until we start doing our jobs and educating the community to CPR and have the vehicles to deliver a defibrillator in 4 minutes or less, we are wasting our time. Pour the whole drug box in them everytime, you still will have less than 10% that walk out of the hospital.

as the sums from in hospital arrests show ... I think i'm doing well with a 66% ROSC and 33% 6 month survival on my last couple of years of in hospital Cardiac arrests ( make it 75% and 50% if you include the guy who never quite made it to peri-arrest thanks to my my colleague and a switched on locum Doc... and us spotting his hyperkalaaemia and low Mg...

ROsc from pre-hospital arrests generally relies on the first 3 links of the chain of survival being in place and being there in seconds to minutes ... which is why the figures in hospital can seem good as drop to shock in all the places i've worked has been routinely 30-90 seconds

[JPINFV]

Its all a joke, the only thing that saves cardiac arrest patients is immediate CPR and defibrillation. Until we start doing our jobs and educating the community to CPR and have the vehicles to deliver a defibrillator in 4 minutes or less, we are wasting our time. Pour the whole drug box in them everytime, you still will have less than 10% that walk out of the hospital.

...and the only way to reliably meet the 4 minute mark is either widely available public access AEDs (there's an AED in every building at my school, and the new building has one on every floor by the main elevator), or police first response equipped with AEDs. Why the police? Who else is constantly in their vehicle more? For EMS and fire to have a similar response time, they would have to be waiting in their vehicle, engine on, ready to go at all times unless using the facilities, getting food, or while on a call. The minute it takes to throw the boots on and walk to the ambulance is pretty long when it's a 1/4th of the response window, and this isn't even counting the call received to call dispatched interval. Oh, and no more storing response vehicles at the same location. Medical first response engine and an ambulance at the same station? Well, one can go post in the east side of the district and the other in the west side. Gotta cut down on that response time, after all.

[stcommodore]

I wish I worked someone I could worry about taking my shoes off or "out of station" time. I live in my truck.