The American College of Emergency Physicians (ACEP) recommends atropine
as adjunctive therapy to prevent reflex bradycardia
prior to laryngoscopy/tracheal intubation
(L/TI) in pediatric patients.
To describe the incidence of reflex bradycardia
and its relationship to the administration of atropine
during L/TI in a Pediatric Emergency Department.
A retrospective cohort study was designed through review of records of all patients who received L/TI in the ED at an urban children's hospital from January 1997 to March 2001. Patients meeting inclusion criteria were placed into cohorts defined by whether they had received atropine
prior to L/TI or not.
One hundred sixty-three patients received L/TI during the study period. One hundred forty-three patients met inclusion criteria. Sixty-eight patients received atropine
group) prior to L/TI. Seventy-two percent of atropine
group patients met ACEP criteria for atropine
pretreatment. Seventy-five patients did not receive atropine
group). Forty-three percent of no-atropine
group patients met ACEP criteria for pretreatment with atropine
The atropine group was younger [mean 22.5 vs. 36.4 months, P = 0.003, 95% CI (−28.5, 0.70)], averaged the same number of intubation attempts [1.6 vs. 1.5, P = 0.941, 95% CI 0.1 (−0.3,0.4)], and had normal or elevated HR for age prior to L/TI (mean 159 bpm). Hypoxia occurred more often in the atropine group [28% vs. 16%, P = 0.046, 95% CI for difference (0.3, 27.1)].
Bradycardia was noted in 6 patients during L/TI; 3 in the atropine group and 3 in the no-atropine group.
is not routinely administered prior to L/TI in this pediatric ED. Pretreatment with atropine
did not prevent bradycardia in all cases. These data suggest that use of atropine
prior to L/TI may not be required for all pediatric patients. Some patients will experience bradycardia regardless of atropine