Aminophylline in undifferentiated out-of-hospital asystolic cardiac arrest.
OBJECTIVE
To determine if the introduction of intravenous aminophylline, a nonspecific adenosine receptor antagonist, into the resuscitation algorithm of asystole will increase return of spontaneous circulation when used in undifferentiated prehospital cardiac arrest.


METHODS
An urban, prehospital, prospective, randomized, double-blind, placebo-controlled trial of nonpregnant normothermic adults suffering nontraumatic out-of-hospital asystolic cardiac arrest. Subjects were treated in accordance with published advanced cardiac life support guidelines and standard pharmacotherapy. They were randomly assigned to receive either placebo or aminophylline along with the initial boluses of atropine and epinephrine. Cardiac rhythms and carotid pulses were monitored throughout the resuscitation.


RESULTS
Eighty-two patients were entered into the trial. Forty-five patients were assigned to the placebo group and 37 received aminophylline. Nine of 45 controls (20%; 95% CI 10-35%) achieved return of spontaneous circulation compared to ten of 37 (27%; 95% CI 14-44%) in the aminophylline group.


CONCLUSIONS
We were not able to show a statistically significant improvement in return of spontaneous circulation when aminophylline was given during the early resuscitation phase of undifferentiated asystolic cardiac arrest in the prehospital setting with this sample size.
Mader
T J
TJ
Department of Emergency Medicine, Tufts University School of Medicine, Boston, MA, USA. doct@maderfamily.com
Smithline
H A
HA
Gibson
P
P
D000368:Aged; D000465:Algorithms; D000628:Aminophylline / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D058915:Purinergic P1 Receptor Antagonists; D012151:Resuscitation / Q000379:methods*
D058915:Purinergic P1 Receptor Antagonists; D000628:Aminophylline