In-hospital cardiopulmonary resuscitation during asystole. Therapeutic factors associated with 24-hour survival.
The most recent American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) during asystole include ventricular defibrillation, intubation, and the administration of epinephrine and atropine. This study reports results from a retrospective analysis of clinical, demographic, and treatment data collected during in-hospital CPR efforts in 123 patients in whom the initial rhythm was asystole. Twenty-eight (22.8 percent) of these patients were alive 24 h after CPR initiation. Patients who received norepinephrine drip (N = 43) were more likely to survive than those who did not (39.5 percent vs 14.1 percent; p less than .01), and those who received lidocaine drip were more likely to survive than those who did not (47.6 percent vs 18.2 percent; p less than .01). The best survival rate (57.1 percent) occurred among those who received both norepinephrine and lidocaine (N = 14). Survivors did not differ significantly from nonsurvivors in terms of age, gender, primary diagnosis, location of arrest, or duration of CPR efforts. The results suggest that aggressive resuscitation efforts which include the addition of norepinephrine and lidocaine drips to the AHA-recommended regimen of epinephrine and atropine may substantially increase the number of 24-h survivors. A pharmacologic mechanism involving norepinephrine-induced myocardial irritability and peripheral vasoconstriction, combined with lidocaine-induced suppression of abnormal automaticity, is offered as a possible explanation of the obtained results.
North Shore University Hospital, Manhasset, NY.
A J
AJ
Tortolani
D A
DA
Risucci
S R
SR
Powell
R
R
Dixon
D001285:Atropine / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D009518:New York; D009638:Norepinephrine / Q000627:therapeutic use; D012151:Resuscitation / Q000401:mortality; D012189:Retrospective Studies
D001285:Atropine; D008012:Lidocaine; D009638:Norepinephrine