Abstract 154: Guideline Removal of Atropine and Survival After Adult In-Hospital Cardiac Arrest With Non-Shockable Rhythms

Abstract

Introduction: Atropine was removed from the 2010 American Heart Association’s Advanced Cardiac Life Support guidelines as routine management of non-shockable cardiac arrest, although the evidence to support or refute the use of atropine is lacking. In a previous study, atropine usage was shown to subsequently decline markedly. Whether removing atropine from the guidelines has affected survival remains unknown. Methods: Using the Get With The Guidelines®-Resuscitation registry, we included adult patients with an index in-hospital cardiac arrest between 2006-2015. Non-shockable and shockable cardiac arrest patients with high vs. low propensity score to receive atropine were separated into two cohorts. An interrupted time-series analysis was used to compare survival before (pre-exposure) and after (post-exposure) introduction of the 2010 guidelines. A difference-in-difference approach was used to compare the interrupted time-series results between the non-shockable and shockable cohorts to account for guideline changes unrelated to atropine. Results: We included 21,822 non-shockable and 4,268 shockable cardiac arrests. Patient characteristics were similar between the pre-exposure and post-exposure period. Atropine was used for 9,170 (86%) non-shockable and 733 (34%) shockable cardiac arrests in the pre-exposure period and 3,903 (35%) non-shockable and 339 (16%) shockable cardiac arrests in the post-exposure period. The change over time in survival from the pre-exposure to the post-exposure period was not significantly different for the non-shockable compared to the shockable cohort (mean difference: 2.0% [95%CI: -0.7, 4.6] per year, p = 0.15, Figure). The immediate change in survival after introducing the guidelines was also not different between the cohorts (mean difference: 3.9% [95%CI: -2.2, 10], p = 0.21, Figure). Conclusions: The removal of atropine from the 2010 guidelines was not associated with a change in survival in our analysis.

Recent advances in electrochemical C–H bond amination

“…Amine-containing natural products are highly versatile and have been used as drugs with antispasmodic, 10 analgesic, 11 sedative, 12 antimalarial, 13 insecticidal, 14 neurological, 15 and other effects (Scheme 1a). Besides, skeletons of amines are present in various synthetic pharmaceuticals (Scheme 1b).…”