If you encounter bradycardia, don’t think “atropine deficiency,” think “oxygen deficiency.” - Sean M. Fox MD


image by: Atropine

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Did Removal of Atropine From ACLS Impact Survival?

ACLS guidelines were changed in 2010, and atropine was removed. In this propensity score analysis from 2006-2015, which spanned this change, survival was not impacted in patients with a non-shockable rhythm. In fact, it increased slightly, though not statistically significantly, after removing atropine from the treatment armamentarium. There was also no difference in survival with good functional outcome after atropine was dropped. Shockable rhythm survival had a small decrease post-2010 guideline, which needs further study.

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 Did Removal of Atropine From ACLS Impact Survival?

Removal of atropine from the ACLS algorithm did not result in a decrease in survival in patients with non-shockable rhythms.


Atropine is the first-line therapy (Class IIa) for symptomatic bradycardia in the absence of reversible causes. While atropine can be used independently for anti-salivation effects, it most commonly is secondary to anticholinergic or antimuscarinic poisoning.

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