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Atropine for Emergency Intubation

Question Type:
Intervention
Full Question:
In infants and children requiring emergency tracheal intubation (P), does does the use of atropine as a premedication (I), compared with compared with not using atropine (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, incidence of cardiac arrest, Survival with favorable neurological outcome at 1 year follow up, Survival with favorable neurological outcome at 180 days, survival to hospital discharge, Survival with favorable neurological outcome at 90 days, Survival with favorable neurological outcome at 30 days follow up, Survival with favorable neurological outcome at discharge, the likelihood of cardiac arrest, Likelihood of shock, incidence of arrhythmias, the likelihood of shock, incidence of arrhythmias (O)?
Consensus on Science:
For the critical outcome of survival with favorable neurologic outcome, we identified no evidence that addressed any effect on survival when atropine was used for in-hospital emergency intubation. For the critical outcome of survival to ICU discharge, there was very-low-quality evidence (downgraded for risk of bias and imprecision) from 1 pediatric observational study of in-hospital emergency intubation(Jones 2013, e57478) of 264 infants and children supporting the use of atropine preintubation for those patients at more than 28 days of life. The use of atropine preintubation for neonates was not significantly associated with survival to ICU discharge (neonates: propensity score adjusted odds ratio [aOR], 1.3; 95% CI, 0.31–5.10; P=0.74; older children: odds ratio [OR], 0.22; 95% CI, 0.06–0.85; P=0.028). For the critical outcome of likelihood/incidence of cardiac arrest, we identified no evidence that addressed the effect of atropine use for in-hospital emergency intubation on cardiac arrest. For the important outcome of likelihood or incidence of shock or arrhythmias, we identified very-low-quality evidence (downgraded for risk of bias, inconsistency, and imprecision) from 2 pediatric observational studies. One study of 322 emergency pediatric intubations(Jones 2013, e289-e297) showed that the use of atropine preintubation was associated with a reduced incidence of any arrhythmia (OR, 0.14; 95% CI, 0.06–0.35), whereas the second study of 143 emergency pediatric intubations(Fastle 2004, 651-655) failed to find an association between the preintubation use of atropine and a reduced incidence of bradycardia (OR, 1.11; 95% CI, 0.22–5.68).
Treatment Recommendation:
The confidence in effect estimates is so low that the panel decided a recommendation was too speculative.
CoSTR Attachments:
(Peds Atropine) Exporting COSTaR Data from SEERS.docx.docx    
(Peds Atropine) GRADE Grid and Recommendations.docx    
Atropine CoSTaR (Feb 14th 2015).docx    

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