Pretreatment With Atropine Linked to Cardiopulmonary Events After Intubation in Children

By Louise Gagnon

VIRTUAL -- November 3, 2021 -- The prophylactic use of atropine was associated with an increase in cardiopulmonary events post-intubation in the emergency paediatric setting, according to a study presented at the 2021 Annual Meeting of the American College of Emergency Physicians (ACEP).

The study was a secondary analysis of prospectively-collected data from the National Emergency Airway Registry. 

“The role [of atropine] in emergency paediatric intubation remains unclear,” said Taylor McCormick, MD, Denver Health, Denver, Colorado. “The PALS [Pediatric Advanced Life Support] guidelines recommend against the routine use of prophylactic atropine when intubating critically ill infants and children, but stated it may be reasonable in specific situations with high risk of bradycardia such as when using succinylcholine for paralysis.”

For the study, the researchers analysed 612 paediatric intubations, with 139 being in patients aged younger than 1 year, 129 being in those aged 1 to 3 years, and 144 being in those aged 3 to 8 years, and 200 in those aged 8 to 15 years. Atropine was administered prophylactically in 7% of intubations, of which 51% were in patients aged younger than 1 year. Adverse events occurred in 16% of intubation attempts, with bradycardia occurring in 2% of attempts.

 “As there were only 14 patients with bradycardia following intubation in the whole cohort, we were unable to model the association between bradycardia and atropine pre-treatment while controlling for important covariates,” noted Dr. Dr. McCormick. “Instead, we used a composite outcome of bradycardia, which included hypotension, cardiac arrest, and hypoxia, which we thought would capture the important sequelae of bradycardia.”

After adjusting for confounding variables, atropine pretreatment was associated with an increased occurrence of cardiopulmonary adverse events, with an odds ratio of 2.60 (95% confidence interval, 1.02-6.61). The finding challenges its prophylactic use to avoid bradycardia in emergency pediatric intubation, said Dr. McCormick.

“Preventing bradycardia [after intubation] is how atropine has been reported to help in intubation,” said Dr. McCormick, who stressed that more research is needed to examine the link between pre-treatment atropine and cardiopulmonary events in the emergency pediatric intubation.

[Presentation title: Atropine Pretreatment in Adverse Events in Emergency Pediatric Intubations. Abstract 389]