ACLS - Bradycardia 

Updated: Mar 21, 2014
  • Author: James J Lamberg, DO; Chief Editor: Meda Raghavendra (Raghu), MD  more...
  • Print

Advanced Cardiac Life Support (ACLS): Bradycardia

1. Initial evaluation [1, 2, 3]

  • Assess appropriateness for clinical condition
  • Heart rate typically < 50 bpm in bradyarrhythmia

2. Initial intervention

  • Maintain patent airway
  • Assist breathing as needed
  • Administer oxygen if hypoxemic
  • Attach monitor/defibrillator
  • Monitor blood pressure and oximetry
  • Obtain intravenous (IV)/intraosseous (IO) access
  • Perform 12-lead electrocardiography (ECG); do not delay therapy

3. Assess for signs of poor perfusion

  • Hypotension (systolic blood pressure [SBP] < 90 mm Hg)
  • Acutely altered mental status
  • Signs of shock
  • Ischemic chest discomfort
  • Acute heart failure

4. Therapeutic intervention

  • If poor perfusion present, administer atropine
  • If adequate perfusion present, monitor and observe

5. Measures if atropine is ineffective

  • Transcutaneous pacing OR dopamine infusion OR epinephrine infusion
  • Consider expert consultation and transvenous pacing

Drug therapy

See the list below:

  • Atropine 0.5 mg IV q3-5min; maximum dose, 3 mg
  • Dopamine 2-10 μg/kg/min infusion
  • Epinephrine 2-10 μg/min infusion

Atropine

See the list below:

  • Not reliable for third-degree block or second-degree type II block
  • Could potentially exacerbate the block by increasing sinoatrial (SA) node activation
  • Not useful in transplanted hearts