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Abstract
Atropine can have a place during cardiopulmonary resuscitation (CPR) in the management
of asystole, where parasympathetic influence might be excessive. However, the beneficial
effects of atropine in electromechanical dissociation (EMD) have not been clearly
demonstrated. The authors studied the effects of atropine in combination with epinephrine
on an experimental model of EMD in the closed-chested dog. In 15 pentobarbital-anesthetized,
mechanically ventilated dogs (mean weight 20 kg), EMD was induced by ventricular fibrillation
followed by an external countershock, and was observed for 2 minutes before CPR was
stared. After 5 minutes of chest compression using a CPR thumper, either atropine
0.5 mg or D5W was administered, and the same injection was repeated every 5 minutes until recovery.
Epinephrine 1 mg was administered in alternans. Each dog was submitted to two successive
episodes of CPR, using either atropine or D5W, in a randomized order. Of a total of 28 CPRs, five were successful with chest compression
alone. In the treatment groups, 10 of 11 were successful with atropine, but only eight
of 12 with D5W (P < .01). The duration of CPR was also significantly shorter when atropine was used
(9 minutes 56 seconds ± 14 seconds versus 12 minutes 08 seconds ± 43 seconds, P < .001). During the recovery period, atropine-treated animals had higher arterial
pressure, heart rate, cardiac output and stroke volume. On this experimental model,
the administration of high doses of atropine together with epinephrine enhances the
recovery from EMD and results in a better cardiac function during recovery.
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Article Info
Publication History
Accepted:
May 20,
1992
Received:
January 28,
1992
Identification
Copyright
© 1992 Published by Elsevier Inc.
