Asystole in ECT

Letter to the Editor

Sir: In an excellent discussion of asystole in electroconvulsive
therapy, Dr. McCall makes a number of useful suggestions
to minimize the likelihood that asystole will occur. I would like
to amplify his treatment recommendation of intravenous atropine
injection. Without cardiac function during asystole, atropine
administered through a peripheral vein will not reach the
heart unless "pushed" by a 20- to 30-mL fluid bolus followed by
elevation of the arm.