PEA / Asystole Date Last Search Run: Aug 01, 2024 Table last updated: Dec 09, 2019 Data last added: Dec 12, 2016

Recommendation		RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION		SUPPORTIVE (Green)	NEUTRAL (Yellow)	AGAINST (Red)	NOT YET GRADED (White)
	1 (strong evidence exists)		Aminophylline Fibrinolysis
	2 (fair evidence exists)		Anticholinergic Transcutaneous Pacing
	3 (weak evidence exists)

Interventions

Aminophylline

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
I	Neutral (Yellow)	Survival	Patient	PH-Paramedic & CCT	Abu-Labaan RB., et al. Aminophylline in bradysystolic cardiac arrest: a randomised placebo-controlled trial. Lancet 2006; 367:1577-84. Medline
I	Neutral (Yellow)	Survival to hospital DC.	Patient	PH-Paramedic	Hurley KF., Magee K., Green R. Aminophylline for bradyasystolic cardiac arrest in adults. Cochrane Database Syst Rev 2013; 8:CD006781. Medline
I	Neutral (Yellow)	ROSC	Patient	PH-Paramedic	Mader TJ., Smithline HA., Durkin L., Scriver G. A Randomized Controlled Trial of Intravenous Aminophylline for Atropine-resistant Out-of hospital Asystolic Cardiac Arrest. Acad Emerg Med 2003; 10(3)192-7. Medline

Anticholinergic

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
II	Neutral (Yellow)	mortality	Patient	PH-Paramedic	Coon GA., Clinton JE., Ruiz E. Use of atropine for brady-asystolic prehospital cardiac arrest. Ann Emerg Med 1981; 10(9):462-7. Medline
II	Neutral (Yellow)	30 day favorable neurologic outcome	Patient	PH-Paramedic	SOS-KANTO. Atropine Sulphate for patients with Out-Of-Hospital Cardiac Arrest due to Asystole and Pulseless-electrical Activity. Circ Japan 2011; 75:580-588. Medline
III	Neutral (Yellow)	Survival to DC	Patient	PH-Paramedic	Olasveengen TM., Sunde K., Brunborg C., Thowsen J., Steen PA., Wik L. Intravenous drug administration during out-of-hospital cardiac arrest: A randomized trial. JAMA 2009; 302(20):2222-9. Medline
III	Opposes (Red)	Survival time	Patient	PH-Paramedic	Wang HE., Min A., Hostler D., Chang CC., Callaway CW. Differential effects of out-of-hospital interventions on short- and long-term survival after cardiopulmonary arrest. Resuscitation 2005; 67(1):69-74. Medline

Fibrinolysis

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
I	Neutral (Yellow)	Survival to hospital discharge	Patient	PH-Paramedic	Abu-Laban RB., et al. TPA in Cardiac Arrest with Pulseless Electrical Activity. NEJM 2002; 346: 1522-8. Medline

Transcutaneous Pacing

Level	Direction	Primary Outcome	Patient/Process	Setting	Reference
II	Neutral (Yellow)	Survival to admission/ discharge	Patient	PH-Paramedic	Cummins RO., Graves JR., Larsen MP., Hallstrom AP., Hearne TR., Ciliberti J., Nicola RM., Horan S. Out-of-Hospital Transcutaneous Pacing by EMTs in Patients with Cardiac Arrest. NJM 1993; 328(19):1377-82. Medline
II	Neutral (Yellow)	Presenting to the ED with a pulse	Patient	PH-Paramedic	Hedges JR., Syverud SA., Dalsey WC., Feero S., et al. Prehospital trial of emergency transcutaneous cardiac pacing. Circ 1987; 76(6):1337-43. Medline
III	Neutral (Yellow)	Capture or presence of pulse	Patient	ED-MD	Olson CM., Jastremski MS., Smith RW., Tyndall GJ., et al. External cardiac pacing for out-of-hospital brady-asystolic arrest. Am J Emerg Med 1985; 3(2):129-31. Medline
III	Neutral (Yellow)	Electrical capture and regained pulses	Patient	PH-Paramedic	Paris PM., Stewart RD., Kaplan RM., Whipkey R. Transcutaneous pacing for bradysystolic cardiac arrests in prehospital care. Ann Emerg Med 1985; 14(4) 320-3. Medline
III	Neutral (Yellow)	Functional Pacing for Asystole Following Cardiac Arrest	Patient	ED-MD	Tachakara SS., Jepson E., Beckette W., Barrie R. Successful Transcutaneous External Pacing for Asystole Following Cardiac Arrest. Arch Emerg Med 1988; 5:184-185. Medline
III	Neutral (Yellow)	Time to insertion	Process	ED-MD	White JM., Nowak RM., Martin GB., Best R., et al. Immediate emergency department external cardiac pacing for prehospital bradyasystolic arrest. Ann Emerg Med 1985; 14(4)298-302. Medline