Cardiac arrest: bretylium tosylate increased survival to hospital admission.

Clinical bottom line (level 3b)

Patients with refractory ventricular fibrillation who were given bretylium tosylate as part of advanced life support, were more likely to be admitted to hospital than those not given bretylium.
Patients given bretylium tosylate had no clear difference in discharge from hospital.

Stang et al: Annals of Emergency Medicine 1984; 13 (4): 234-236

Expires October 2003

The study

Case-control study with objective outcomes, ?adjusted for confounding factors, ? validated in an independent set of patients.

Setting: 1 community, USA

35 patients (aged mean 57 years, 74% male) refractory ventricular fibrillation that necessitated transport to hospital
bretylium tosylate added to the advanced cardiac life support protocol, which consists of chest thump, CPR, 2 shocks, lidocaine, bicarbonate, maximum energy defibrillation, epinephrine and another maximum energy shock

Outcomes studied:

admission to hospital bretylium tosylate versus control (control event, 1)
discharge from hospital bretylium tosylate versus control (control event, 1)

The evidence

outcome	time to outcome	number of patients/total number	% (95% CI)	NNF (95% CI)
admission to hospital	?	11/35	31.43% (16.04% to 46.81%)	3 (2 to 6)
discharge from hospital	?	8/35	22.86% (8.94% to 36.77%)	4 (3 to 11)

Comments

The trial is too small to show any clear difference in discharge from hospital between the two groups.

Citation

Stang JM, Washington SE, Barnes SA, et al: Treatment of prehospital refractory ventricular fibrillation with bretylium tosylate. Annals of Emergency Medicine 1984; 13 (4): 234-236

_{Clinical Question.}

_Patient	_{prehospital refractory ventricular fibrillation}
_{Intervention or Exposure}	_{bretylium tosylate}
_Comparison	_{no bretylium tosylate}
_Outcome	_{discharge from hospital}