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Aminophylline and Cardiac Arrest
- Sami Viskin, MD;
- David Sheps, MD; and
- Arie Roth, MD
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IN RESPONSE:
The poor ultimate outcome of our patients is best explained by study criteria requiring at least four injections before concluding that they failed to respond to epinephrine and atropine; thus, only patients with prolonged asystole were included in our study [1]. The ability of epinephrine plus aminophylline (as first-line treatment for asystole) to improve long-term outcome through faster re-establishment of spontaneous cardiac rhythm must, as Drs. Varon and Fromm point out, be proven by controlled studies. Currently, aminophylline can only be recommended for patients with bradyasystolic arrest in whom standard treatment [2] has failed.
In accordance with present recommendations [2], some of our patients received all drugs (including aminophylline) through antecubital veins. This was always followed by saline flushing. Circulation time during closed-chest cardiac massage (defined as the time needed for an injected marker to reach a peripheral artery) may be more than 60 seconds if the marker is injected through an antecubital vein and the time to peak levels at the artery site is measured [3]. However, if the time to first appearance of the same marker is measured, values as low as 25 to 39 seconds may be obtained [3]. In view of the aminophylline dosage used in our study (250 mg in a 10-mL rapid bolus), the last value could better represent the time needed to achieve a cardiac effect. We recognize, however, that the time to response reported by the investigators involved in resuscitation could have been underestimated.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
