Cardiac arrest: bretylium tosylate had no clear effect.

Clinical bottom line (level 2b-)

  1. Patients in cardiac arrest who were given bretylium tosylate, may have slightly better chances in survival to discharge than those given saline (NNT = 6 at years) .
Nowak et al: Annals of Emergency Medicine 1981; 10 (8): 404-407
Expires October 2003

The study

Double-blinded ?concealed quasi-randomised trial with intention-to-treat
Setting: 1 general hospital, USA

57 patients (aged mean 57 years, 71% male) cardiopulmonary arrest

Excluded if
  • cardiac monitor was not operative during part of resuscitation
  • patient not seen by an investigator
  • protocol dosage for the study solution was not followed (post-randomisation exclusion)


    • Control Group: (n = 28, 28 analysed): 0.2 ml/kg saline
    Experimental Group: (n = 29, 29 analysed): intravenous bretylium tosylate-0.2 ml/kg of 10 mg/kg by rapid bolus injection
    The first 4 patients in the study received 0.1 ml/kg of 5 mg/kg bretylium. A second dose of the study solution was given if there was no response after 20 minutes.
    100% followed for ?

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    survival to discharge unknown 3
    (10.7%)    		 8
    (27.6%)    		 19%
    (-5% to 37%)    		 16.87%
    (-3.02% to 36.77%)    		 6
    (NNT = 3 to infinity;
    NNH = 33 to infinity)

    Comments

    1. The trial is too small to show any clear difference in survival to discharge between the two groups.
    2. Treatment followed American Heart Association guidelines.
    3. Lidocaine was used more frequently in the bretylium group and isoproterenol was used more often in the saline group.
    4. 11 adverse reactions occurred in the bretylium group (tachycardia, 5; hypotension, 4; bradycardia, 1; hypertension, 1) compared with 1 in the saline group (hypotension).

    Citation

    1. Nowak RM, Bodnar TJ, Dronen S, et al: Bretylium tosylate as initial treatment for cardiopulmonary arrest: Randomized comparison with placebo. Annals of Emergency Medicine 1981; 10 (8): 404-407
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer:

    Clinical Question.
    Patient cardiopulmonary arrest
    Intervention or Exposure bretylium tosylate
    Comparison saline
    Outcome survival