Experience with bretylium tosylate by a hospital cardiac arrest team.
The effect of bretylium tosylate (BT) was determined in 27 consecutive cases of resistant ventricular fibrillation (VF) encountered by a hospital cardiac arrest team. The VF was sustained and completely resistant to multiple injections of lidocaine, sequential DC shocks at 400 watt-sec and one or a combination of intravenous propranolol, diphenylhydantoin or procainamide. Following 30 min of sustained cardiac massage, BT (5 mg/kg i.v.) was administered. In 20 patients, VF was terminated within 9-12 min after DC shock. Eight of these patients failed to recover while 12 (44%) of all patients resuscitated survived to be discharged from hospital. Eleven out of 20 (55%) of all patients who had a cardiac arrest outside the CCU were survivors; only one out of seven in the CCU were successfully resuscitated. While receiving maintanance BT post-resuscitation (5 mg/kg i.m. q 8-12 hrs x 48 hrs), half the patients developed hypotension and three required vasopressors and/or fluid replacement. The data indicate that BT is a useful agent in patients with sustained VF refractory to repeated lidocaine injections, some other antiarrhythmic agents, and multiple DC shocks.
D001949:Bretylium Compounds / Q000627:therapeutic use*; D001950:Bretylium Tosylate / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D005069:Evaluation Studies as Topic; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications; D012151:Resuscitation; D014693:Ventricular Fibrillation / Q000209:etiology / Q000517:prevention & control
D001949:Bretylium Compounds; D001950:Bretylium Tosylate