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Asystole Medication

  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Dec 26, 2015
 

Medication Summary

Parasympathetic influences during cardiopulmonary arrest have not been elucidated fully, and clinical benefits of atropine have never been 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 are no longer are recommended for children or adults.

Adenosine antagonists, such as aminophylline,[23] 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.

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.

Epinephrine (Adrenaline, EpiPen)

 

Epinephrine is considered the single most useful drug in cardiac arrest; however, some authorities question its clinical effectiveness in humans 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.

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

Sandy N Shah, DO, MBA, FACC, FACP, FACOI Cardiologist

Sandy N Shah, DO, MBA, FACC, FACP, FACOI is a member of the following medical societies: American College of Cardiology, American College of Osteopathic Internists, American College of Physicians, American Osteopathic Association, Society for Cardiovascular Angiography and Interventions, American Society of Nuclear Cardiology, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

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

Disclosure: Medical Director for: SironaHealth.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

Richard M Caggiano, MD, FACEP Adjunct Faculty, Department of Medicine, University of Washington School of Medicine; Chief Medical Officer, Pullman Regional Hospital

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

Disclosure: Nothing to disclose.

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Rhythm strip showing asystole.
Rhythm strip showing ventricular fibrillation.
 
 
 
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