The effect of atropine on rhythm and conduction disturbances during 322 critical care intubations.

Abstract

OBJECTIVES:

Our objectives were to describe the prevalence of arrhythmia and conduction abnormalities before critical care intubation and to test the hypothesis that atropine had no effect on their prevalence during intubation.

DESIGN:

Prospective, observational study.

SETTING:

PICU and pediatric/neonatal intensive care transport.

SUBJECTS:

All children of age less than 8 years intubated September 2007-2009. Subgroups of intubations with and without atropine were analyzed.

INTERVENTION:

None.

MEASUREMENT AND MAIN RESULTS:

A total of 414 intubations were performed in the study period of which 327 were available for analysis (79%). Five children (1.5%) had arrhythmias prior to intubation and were excluded from the atropine analysis. Atropine was used in 47% (152/322) of intubations and resulted in significant acceleration of heart rate without provoking ventricular arrhythmias. New arrhythmias during intubation were related to bradycardia and were less common with atropine use (odds ratio, 0.14 [95% CI, 0.06-0.35], p < 0.001). The most common new arrhythmia was junctional rhythm. Acute bundle branch block was observed during three intubations; one Mobitz type 2 rhythm and five ventricular escape rhythms occurred in the no-atropine group (n = 170). Only one ventricular escape rhythm occurred in the atropine group (n = 152) in a child with an abnormal heart. One child died during intubation who had not received atropine.

CONCLUSIONS:

Atropine significantly reduced the prevalence of new arrhythmias during intubation particularly for children over 1 month of age, did not convert sinus tachycardia to ventricular tachycardia or fibrillation, and may contribute to the safety of intubation.

• Authors: Peter Jones, Stéphane Dauger, Isabelle Denjoy, Nathalia Pinto da Costa, Corinne Alberti, Rym Boulkedid, Mark J Peters
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 14 Issue 6 Pg. e289-97 (Jul 2013) ISSN: 1529-7535 [Print] United States
• PMID: 23689705 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Arrhythmia Agents
• Atropine

Topics

• Anti-Arrhythmia Agents (therapeutic use)
• Arrhythmias, Cardiac (diagnosis, epidemiology, etiology, prevention & control)
• Atropine (therapeutic use)
• Child
• Child, Preschool
• Critical Care (methods)
• Electrocardiography
• Female
• Humans
• Infant
• Infant, Newborn
• Intubation, Intratracheal (adverse effects, methods)
• Logistic Models
• Male
• Multivariate Analysis
• Prevalence
• Prospective Studies
• Treatment Outcome