Use of methoxamine in the resuscitation of epinephrine-resistant electromechanical dissociation.
We describe three cases of electromechanical dissociation under anaesthesia that were unresponsive to doses of intravenous epinephrine given according to current Advanced Life Support guidelines, but which responded immediately to the intravenous administration of the pure alpha agonist, methoxamine. We suggest a possible mechanism to explain this finding and review the literature on vasopressor drugs used for cardiopulmonary resuscitation during electromechanical dissociation. An intravenous alpha agonist, such as methoxamine 20 mg, should be considered for any case of cardiac arrest secondary to electromechanical dissociation which is unresponsive to epinephrine given according to current guidelines.
McBrien
M E
ME
Department of Anaesthesia, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK. michaelmcbrien@yahoo.com
Breslin
D S
DS
Atkinson
S
S
Johnston
J R
JR
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004351:Drug Resistance; D004837:Epinephrine / Q000627:therapeutic use; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D007431:Intraoperative Complications / Q000188:drug therapy*; D008297:Male; D008729:Methoxamine / Q000627:therapeutic use*; D008875:Middle Aged; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000316:Adrenergic alpha-Agonists; D014662:Vasoconstrictor Agents; D008729:Methoxamine; D004837:Epinephrine