title: Randomized study of epinephrine versus methoxamine in prehospital ventricular fibrillation.
abstract: Experimental data suggest that a pure alpha-agonist, such as methoxamine, may improve the outcome of patients in ventricular fibrillation. A double-blind, randomized, prospective study was conducted in a paramedic system comparing the use of methoxamine with epinephrine in enhancing conversion of ventricular fibrillation while otherwise following American Heart Association protocols. One hundred two patients in ventricular fibrillation not responding to initial defibrillations with a pulsatile rhythm were randomized into one of two groups, each containing 51 patients. Equipressor doses of epinephrine (0.5 mg) and methoxamine (5 mg) were given intravenously and repeated according to American Heart Association guidelines. The mean age, sex ratio, and mean paramedic response times were comparable for the two groups. The mean time at scene until conversion was 22 +/- 10 minutes for methoxamine and 17 +/- 7 minutes for epinephrine (P = NS). The methoxamine group received 3.1 +/- 1.4 doses as compared with 2.8 +/- 1.3 doses for the epinephrine group (P = NS). Conversion rate, defined as the percentage of patients who developed a pulse during resuscitation, was 27.5% for the methoxamine group and 49.0% for the epinephrine group (P less than or equal to .03). Successful resuscitation, defined as the conveyance of a patient to an emergency department with a pulse and rhythm, was 17.7% for the methoxamine group and 39.2% for the epinephrine group (P less than or equal to .02). Save rate, defined as the percentage of patients discharged alive after hospitalization, was 7.8% for the methoxamine group and 19.6% for the epinephrine group (P less than or equal to .07).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Section of Trauma and Emergency Medicine, Medical College of Wisconsin, Milwaukee.
authors.forename: D W
authors.initials: DW
authors.lastname: Olson
authors.forename: R
authors.initials: R
authors.lastname: Thakur
authors.forename: H A
authors.initials: HA
authors.lastname: Stueven
authors.forename: B
authors.initials: B
authors.lastname: Thompson
authors.forename: H
authors.initials: H
authors.lastname: Gruchow
authors.forename: G E
authors.initials: GE
authors.lastname: Hendley
authors.forename: K M
authors.initials: KM
authors.lastname: Hargarten
authors.forename: C
authors.initials: C
authors.lastname: Aprahamian
mesh_terms: D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D004554:Electric Countershock; D004634:Emergency Medical Technicians; D004837:Epinephrine / Q000008:administration & dosage*; D005392:First Aid; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy; D006801:Humans; D008729:Methoxamine / Q000008:administration & dosage*; D011446:Prospective Studies; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000401:mortality
chemical_list: D008729:Methoxamine; D004837:Epinephrine