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Aminophylline for Bradyasystolic Cardiac Arrest Refractory to Atropine and Epinephrine

Sami Viskin, MD; Bernard Belhassen, MD; Arie Roth, MD; Meir Reicher, MD; Mordechai Averbuch, MD; David Sheps, MD; Eouni Shalabye, MD; and Shlomo Laniado, MD
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From Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Requests for Reprints: Sami Viskin, MD, Department of Cardiology, Tel Aviv Medical Center, Weizman St. 6, Tel Aviv 64239, Israel. Acknowledgments: The authors thank Drs. Milton Roller, Ariel Finkelstein, Leib Mendelevitch, Samuel Basan, and Ella Raizman for their assistance in the gathering of clinical data.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(4):279-281. doi:10.7326/0003-4819-118-4-199302150-00006
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Endogenous adenosine, which accumulates during hypoxia and ischemia, may perpetuate asystole. Therefore, patients with cardiac arrest were prospectively studied to see if their immediate outcome could be improved with aminophylline, a competitive antagonist of adenosine. Fifteen consecutive patients with cardiac arrest due to asystole or to nonperfusing bradyarrhythmias, who failed to respond to intravenous atropine and epinephrine, were treated with aminophylline (rapid intravenous injection of 250 mg). Establishment of a stable heart rhythm with sufficient blood pressure to allow discontinuation of closed-chest cardiac massage was achieved in 11 of 15 (73%) patients. All these 11 patients were alive 60 minutes after resuscitation. One patient survived, without neurologic damage. We conclude that the immediate outcome of patients with asystole refractory to standard treatment may be improved with aminophylline. Further study is warranted to determine if earlier administration of aminophylline during cardiac arrest will improve long-term outcome.


Grahic Jump Location
Figure 1.
Electrocardiographic recordings from a patient brought to the emergency room after unsuccessful out-of-hospital attempts at resuscitation.

Recordings were done at 25 mm/sec paper speed during momentary discontinuation of closed-chest cardiac massage. First strip (recorded at 20:27 hours in a mobile coronary care unit) shows external cardiac pacing through chest wall leads with 2:1 pacing-block, after atropine (2 mg) plus epinephrine (1 mg) had no effect on asystole. Strips 2 and 3 (recorded at 20:29 and 20:31 hours during transportation to the hospital) show that external pacing with maximal output energy is less effective despite continuous ventilation with 100% oxygen and repeated epinephrine injections (1 and 5 mg). Strip 4 (recorded at the time of arrival to the emergency room, which was 20:32 hours) shows that external pacing was not effective; therefore, it was discontinued. Strip 5 (recorded at 20:34 hours) shows that, after aminophylline administration, sinus rhythm (75 beats/min) is restored. Total elapsed time between the first and fifth ECG strips was 7 minutes.

Grahic Jump Location




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