Atropine removed from updated ACLS guidelines

[Soleus]

Just recently going through the ACLS provider manual and noticed that atropine was removed from the updated guidelines for treatments of cardiac arrest with PEA and asystole. There was a brief paragraph that essentially stated the reasoning (paraphrasing) as atropine being found to be of no detriment but also not being proven to be of any benefit in cardiac arrest.

This new algorithm was news to me and caught me by surprise seeing as that I feel like, as anesthesiologists, we should know ACLS better than anyone in the hospital, with the exception of intensivists, and I knew nothing about this. Can anyone elaborate further on why the change (and the data/literature)? Also, was anyone else as surprised by this change as me?

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[pgg]

Also, was anyone else as surprised by this change as me?

Not really surprised by that, though I'm not sure I'd never give atropine for slow PEA because ACLS told me not to.

I was surprised that the new AHA ACLS student book algorithm for bradycardia lists atropine for all kinds of AV block as the first line treatment, to be followed by pacing and epi/dopamine infusions. Later in the drug appendix it does acknowledge that atropine won't be useful for high grade blocks. But the flow chart / cards have atropine for the thirds and type 2 seconds.

I wonder if this is just more dumbing down of ACLS. In the past when I've taught ACLS, the hardest part for new non-physician students has always been recognizing type 1 vs 2 second degree blocks and picking atropine vs transcutaneous pacing as their first intervention. Now they don't have to recognize anything more than "it's slow" and have one treatment to remember.

 

[Apollyon]

Not really surprised by that, though I'm not sure I'd never give atropine for slow PEA because ACLS told me not to.

I was surprised that the new AHA ACLS student book algorithm for bradycardia lists atropine for all kinds of AV block as the first line treatment, to be followed by pacing and epi/dopamine infusions. Later in the drug appendix it does acknowledge that atropine won't be useful for high grade blocks. But the flow chart / cards have atropine for the thirds and type 2 seconds.

I wonder if this is just more dumbing down of ACLS. In the past when I've taught ACLS, the hardest part for new non-physician students has always been recognizing type 1 vs 2 second degree blocks and picking atropine vs transcutaneous pacing as their first intervention. Now they don't have to recognize anything more than "it's slow" and have one treatment to remember.

The caveat has always been, though, to not withhold TCP waiting for atropine to act. As such, it's "no harm, no foul".

At the same time, I don't think that giving atropine for PEA/asystole is a "critical fail".

Then again, I'm just a dumb ER doc.

 

[jetproppilot]

The caveat has always been, though, to not withhold TCP waiting for atropine to act. As such, it's "no harm, no foul".

At the same time, I don't think that giving atropine for PEA/asystole is a "critical fail".

Then again, I'm just a dumb ER doc.

Yeah, ok.

No dude, you're

DA MAN.

I'm giving atropine 2 mg IV regardless of what the "professionals" say.😀

I've got some compelling

albeit anecdotal

stories of how atropine helped me

come off pump

with

MANY

coronary artery bypass graft surgeries

that had temporarily

GONE AWRY

during the transition period.

So the

ADMINISTRATIVE PROFESSIONALS

can write it off all they want.

IN A PINCH, FLATLINE, HEART RATE 20, WHATEVER,

I'm slippin' some atropine,

SINCE IT'S SAVED MY A S S COMING OFF BYPASS

MANY TIMES.

MAY WORK,

MAY NOT.

But I will

SLIP IT

just to make sure.

 

[MTGas2B]

Agree that its likely a dumbing down maneuver. I renewed my ACLS just before the latest refresh.

I assume they would still keep it in PALS though. When is PALS due for its latest update? I'm taking that renewal in October.

 

[Idiopathic]

i give it with the epi, in my heart i believe they augment each other

if youve tried everything inside the box, sometimes it becomes necessary to step outside the box before declaring a patient