title: Aminophylline for bradyasystolic cardiac arrest in adults.
abstract: BACKGROUND
  In cardiac ischaemia, the accumulation of adenosine may lead to or exacerbate bradyasystole and diminish the effectiveness of catecholamines administered during resuscitation. Aminophylline is a competitive adenosine antagonist. Case studies suggest that aminophylline may be effective for atropine-resistant bradyasystolic arrest.
  
  
  OBJECTIVE
  To determine the effects of aminophylline in the treatment of patients in bradyasystolic cardiac arrest, primarily survival to hospital discharge. We also considered survival to admission, return of spontaneous circulation, neurological outcomes and adverse events.
  
  
  METHODS
  For this updated review, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, LILACS, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform in November 2014. We checked the reference lists of retrieved articles, reviewed conference proceedings, contacted experts and searched further using Google.
  
  
  METHODS
  All randomised controlled trials comparing intravenous aminophylline with administered placebo in adults with non-traumatic, normothermic bradyasystolic cardiac arrest who were treated with standard advanced cardiac life support (ACLS).
  
  
  METHODS
  Two review authors independently reviewed the studies and extracted the included data. We contacted study authors when needed. Pooled risk ratio (RR) was estimated for each study outcome. Subgroup analysis was predefined according to the timing of aminophylline administration.
  
  
  RESULTS
  We included five trials in this analysis, all of which were performed in the prehospital setting. The risk of bias was low in four of these studies (n = 1186). The trials accumulated 1254 participants. Aminophylline was found to have no effect on survival to hospital discharge (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.12 to 2.74) or on secondary survival outcome (survival to hospital admission: RR 0.92, 95% CI 0.61 to 1.39; return of spontaneous circulation: RR 1.15, 95% CI 0.89 to 1.49). Survival was rare (6/1254), making data about neurological outcomes and adverse events quite limited. The planned subgroup analysis for early administration of aminophylline included 37 participants. No one in the subgroup survived to hospital discharge.
  
  
  CONCLUSIONS
  The prehospital administration of aminophylline in bradyasystolic arrest is not associated with improved return of circulation, survival to admission or survival to hospital discharge. The benefits of aminophylline administered early in resuscitative efforts are not known.
authors.affiliation: Department of Emergency Medicine, IWK Health Centre, 5850/5980 University Ave, PO Box 9700, Halifax, NS, Canada, B3K 6R8.
authors.forename: Katrina F
authors.initials: KF
authors.lastname: Hurley
authors.forename: Kirk
authors.initials: K
authors.lastname: Magee
authors.forename: Robert
authors.initials: R
authors.lastname: Green
mesh_terms: D000368:Aged; D000628:Aminophylline / Q000627:therapeutic use*; D001919:Bradycardia / Q000150:complications; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis
chemical_list: D002316:Cardiotonic Agents; D000628:Aminophylline