Magnesium sulfate in the treatment of refractory ventricular fibrillation in the prehospital setting.
OBJECTIVE
To determine if magnesium sulfate (MgSO(4)) improves outcome in cardiac arrest patients initially in ventricular fibrillation (VF).


METHODS
Randomized, prospective, double blind, placebo-controlled, multicenter prehospital trial using 2 g of MgSO(4). Eligible patients were non-traumatic cardiac arrest patients (> or =18 years of age) presenting in VF. The protocol included those patients refractory to three electroshocks. Epinephrine and either 2 g of MgSO(4) or placebo (normal saline) were then administered. The primary outcome variable was return of spontaneous circulation (ROSC) in the field and a perfusing pulse on arrival at the ED. Secondary endpoints included admission to the hospital (ADMT) and hospital discharge (DISC). IRB approval was obtained at all participating centers.


RESULTS
Total 116 patients (58 MgSO(4), 58 placebo) were enrolled during the period from 4/1992 to 10/96 with 109 available. There were no significant differences between the groups in baseline characteristics and times to cardio pulmonary resuscitation (CPR), advanced life support (ALS), and first defibrillation, except for time to study drug administration. There was no significant differences in ROSC (placebo, 18.5%, and MgSO(4), 25.5%, P=0.38), ADMT (placebo rate=16.7%, MgSO(4)=16.4%, P=1.0) or DISC (placebo rate=3.7%, MgSO(4)=3.6%, P=1.0).


CONCLUSIONS
We failed to demonstrate that the administration of 2 g of MgSO(4) to prehospital cardiac arrest patients presenting in VF improves short or long term survival.
Allegra
J
J
Morristown Memorial Hospital, Department of Emergency Medicine, 100 Madison Ave., Morristown, NJ, USA. johnalle@aol.com
Lavery
R
R
Cody
R
R
Birnbaum
G
G
Brennan
J
J
Hartman
A
A
Horowitz
M
M
Nashed
A
A
Yablonski
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D016887:Cardiopulmonary Resuscitation; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications / Q000188:drug therapy*
D000889:Anti-Arrhythmia Agents; D008278:Magnesium Sulfate