Emergent Management of Asystole Medication

  • Author: Richard M Caggiano, MD, FACEP; Chief Editor: David FM Brown, MD   more...
 
Updated: Aug 8, 2011
 

Medication Summary

Parasympathetic influences during cardiopulmonary arrest have not been elucidated fully, and the clinical benefits of atropine have yet to be confirmed.

Atropine is no longer recommended by the American Heart Association (AHA) for asystole and pulseless electrical activity (PEA).

High-dose epinephrine (0.20 mg/kg) may improve the hemodynamics of cardiopulmonary resuscitation (CPR), thereby increasing the rate of return to spontaneous circulation; however, this agent has not been demonstrated to influence the final clinical outcome. Therefore, high doses no longer are recommended for children or adults.

Adenosine antagonists, such as aminophylline,[20] have been investigated but have not been shown to be clinically useful.

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Anticholinergic agents

Class Summary

The goal in using anticholinergic agents is to enhance sinoatrial (SA) activity and to improve conduction through the SA or atrioventricular (AV) node by reducing vagal tone via muscarinic receptor blockade. This is effective only if the site of the block is within the SA or AV node. For patients with infranodal block, anticholinergic therapy is ineffective, and it may increase a Mobitz II second-degree block to a higher degree of block or a third-degree block.

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Atropine IV/IM (Atropine, Sal-Tropine, AtroPen)

 

Atropine is a parasympatholytic agent used to eliminate vagal influence on the SA and AV nodes. This agent is not effective for infranodal third-degree heart block, PEA, and asystole.

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Adrenergic agonists

Class Summary

Adrenergic agents can produce constriction of skeletal and vascular muscle.

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Epinephrine (Adrenaline, EpiPen)

 

Epinephrine is considered the single most useful drug in cardiac arrest. This agent is used to increase coronary and cerebral blood flow during cardiopulmonary resuscitation (CPR) and may enhance automaticity during asystole. In addition, epinephrine can be used for bradycardia in adult and pediatric patients.

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Vasopressin (Pitressin)

 

Vasopressin has vasopressor and antidiuretic hormone (ADH) activity. This agent increases water resorption at the distal renal tubular epithelium (ADH effect) and promotes smooth muscle contraction throughout the vascular bed via stimulation of V1 receptors (vasopressor effect). Vasoconstriction is increased in splanchnic, portal, coronary, cerebral, peripheral, pulmonary, and intrahepatic vessels.

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Contributor Information and Disclosures
Author

Richard M Caggiano, MD, FACEP  Adjunct Faculty, Department of Medicine, University of Washington School of Medicine; Director of Emergency Services, Chief Medical Officer, and Assistant Director of Trauma Services, Pullman Regional Hospital; Medical Physician Director, Whitman County, Washington

Richard M Caggiano, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Edward Bessman, MD  Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine

Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gary Setnik, MD  Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School

Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position; ProceduresConsult.com Royalty Other

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Rhythm strip showing asystole.
Rhythm strip showing ventricular fibrillation.
 
 
 
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