Cardiac arrest: no clear role for magnesium in out-of-hospital cardiac arrest.

Clinical bottom line (level 1b-)

  1. Patients with an out-of-hospital cardiac arrest who received magnesium were not clearly more likely to regain spontaneous circulation or survive to leave the emergency department.
  2. Magnesium was given on arrival in the hospital, not on-scene.
Fatovich et al: Resuscitation 1997; 35: 237-241
Expires November 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: acute hospital, Australia.

67 patients (aged mean 64, 84% male) with an out-of-hospital cardiac arrest transferred to emergency department.

Excluded if
  • dead on arrival and not receiving CPR
  • already successfully resuscitated
  • cardiac arrest due to trauma, poisoning, suicide, drowning, hypoxia, exsanguination, cerebrovascular accident or subarachnoid haemorrhage


    • Note:
  • Patients were resuscitated using ACLS protocols.


    • Control Group: (n = 36, 36 analysed): placebo
    Experimental Group: (n = 31, 31 analysed): magnesium sulfate 5 g (20 mmol in 10 ml) as an iv bolus

    100% followed for ? years

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    return of spontaneous circulation unknown 8
    (22.2%)    		 7
    (22.6%)    		 2%
    (-58% to 148%)    		 0.36%
    (-19.67% to 20.39%)    		 279
    (NNT = 5 to infinity;
    NNH = 5 to infinity)
    survived to leave emergency department unknown 4
    (11.1%)    		 4
    (12.9%)    		 16%
    (-68% to 330%)    		 1.79%
    (-13.9% to 17.4%)    		 56
    (NNT = 6 to infinity;
    NNH = 7 to infinity)

    Comments

    1. The study is far too small to exclude any difference between the two groups.

    Citation

    1. Fatovich DM, Prentice DA, Dobb GJ: Magnesium in cardiac arrest (the magic trial). Resuscitation 1997; 35: 237-241
    Search Terms: arrest in Cochrane
    Contributor: Chris Ball and Musab Hayatli, November 1999
    Reviewer: Kenneth Ballew

    Clinical Question.
    Patient out-of-hospital cardiac arrest
    Intervention or Exposure magnesium
    Comparison placebo
    Outcome survival