Did Removal of Atropine From ACLS Impact Survival?

Written by Clay Smith

Spoon Feed
Removal of atropine from the ACLS algorithm did not result in a decrease in survival in patients with non-shockable rhythms.

Why does this matter?
When national guidelines are changed, it’s important to make sure the changes result in good or at least no harm. So did this change help, hurt, or make no difference?

One less drug to remember
ACLS guidelines were changed in 2010, and atropine was removed. In this propensity score analysis from 2006-2015, which spanned this change, survival was not impacted in patients with a non-shockable rhythm. In fact, it increased slightly, though not statistically significantly, after removing atropine from the treatment armamentarium. There was also no difference in survival with good functional outcome after atropine was dropped. Shockable rhythm survival had a small decrease post-2010 guideline, which needs further study.

Another Spoonful
Emergency Medicine Cases discussed this change in depth when it first happened. Find out why atropine was dropped from ACLS.

From cited article. Shockable with slight decline post-2010 change (top); non-shockable with non-significant increase post-atropine removal (bottom).

From cited article. Shockable with slight decline post-2010 change (top); non-shockable with non-significant increase post-atropine removal (bottom).

Source
Guideline removal of atropine and survival after adult in-hospital cardiac arrest with a non-shockable rhythm. Resuscitation. 2019 Feb 13. pii: S0300-9572(19)30022-X. doi: 10.1016/j.resuscitation.2019.02.002. [Epub ahead of print]

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Reviewed by Thomas Davis

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