Aminophylline in bradyasystolic cardiac arrest: a randomised placebo-controlled trial

Abu‐Laban, Riyad B.; McIntyre, Caroline; Christenson, James M.; Beek, Catherina A. van; Innes, Grant; O'Brien, Robin K; Wanger, Karen; McKnight, R. Douglas; Gin, Kenneth; Zed, Peter J.; Watts, Jeffrey L.; Puskaric, Joe; MacPhail, Iain; Berringer, Ross; Milner, Ruth

doi:10.1016/s0140-6736(06)68694-7

Cited by 34 publications

(16 citation statements)

References 33 publications

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“…Despite promising small studies, a large randomized, placebo-controlled Canadian trial by Abu-Laban and colleagues found an increase in nonsinus tachyarrhythmias but no increase in return of spontaneous circulation from aminophylline in prehospital patients with bradyasystolic cardiac arrest. 10 Although mild side effects are not uncommon, dipyridamole is considered a relatively safe drug. In a study of 3,911 patients receiving dipyridamole intravenously during a stress test, 10 had serious adverse events: 4 had myocardial infarctions, two of which were fatal, and 6 had bronchospasm.…”

Section: Discussionmentioning

confidence: 99%

Surviving a stressful MIBI scan

Gooch

Bryski

Courvoisier-Grzywacz

2013

CJEM

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Dipyridamole/technetium sestamibi scans (more commonly known as MIBI scans, an acronym for methoxyisobutyl isonitrile) are used commonly for the diagnosis and risk stratification of coronary artery disease. Adverse events from MIBI scans are extremely rare. We present the case of a 64-year-old man who was successfully resuscitated after two asystolic episodes following dipyridamole infusion for a MIBI scan. The second asystolic episode occurred in the emergency department 40 minutes after the patient had been transferred from the Cardiac Stress Test Laboratory. To our knowledge, there are no previous reports of patients having two discrete asystolic episodes or an asystolic episode as delayed as we report after a MIBI scan. Our case illustrates why emergency physicians should be aware of the potential for asystole following MIBI scanning and why aminophylline, the antidote for dipyridamole, should be readily available in emergency departments that could see patients after pharmacologic stress testing. Patients who become asystolic following dipyridamole infusion likely require prolonged cardiac monitoring, given the potential for further episodes after periods of hemodynamic stability. RÉ SUMÉLes scintigraphies au dipyridamole-techné tium sestamibi (mieux connues sous le nom de scintigraphies au MIBI, acronyme anglais de mé thoxy-isobutyl-isonitrile) servent souvent au diagnostic et à la classification du risque de maladie coronarienne. Les é vé nements indé sirables dé coulant des scintigraphies au MIBI sont extrê mement rares. Nous exposons le cas d'un homme de 64 ans qui a é té ré animé avec succè s à la suite de deux é pisodes d'asystole, consé cutifs à la perfusion de dipyridamole en vue d'une scintigraphie au MIBI. Le deuxiè me é pisode est survenu au service des urgences, 40 minutes aprè s la mutation du patient du laboratoire d'é preuves d'effort cardiaque. À notre connaissance, il n'existe pas de rapport anté rieur de deux é pisodes distincts d'asystole ou tout au moins d'un é pisode d'asystole survenu aussi tardivement aprè s une scintigraphie au MIBI. Le cas dé crit dé montre trè s bien pourquoi les mé decins d'urgence devraient ê tre conscients du risque d'asystole à la suite d'une scintigraphie au MIBI et pourquoi il faudrait que les services d'urgence susceptibles de recevoir des patients aprè s une é preuve d'effort mé dicamenteuse aient à la porté e de la main de l'aminophylline, l'antidote du dipyridamole. Il ne fait aucun doute que les patients qui subissent un é pisode d'asystole aprè s une perfusion de dipyridamole doivent faire l'objet d'une surveillance cardiaque prolongé e, compte tenu du risque d'é pisodes ulté rieurs d'arrê t cardiaque aprè s des pé riodes de stabilité hé modynamique.Keywords: aminophylline, asystole, dipyridamole, MIBI Dipyridamole/technetium sestamibi scans (more commonly known as MIBI scans, an acronym for methoxyisobutyl isonitrile) are used commonly for the diagnosis and risk stratification of coronary artery disease. Adverse events from MIBI scans are extre...

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Section: Discussionmentioning

confidence: 99%

Surviving a stressful MIBI scan

Gooch

Bryski

Courvoisier-Grzywacz

2013

CJEM

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“…1 If there was no change in rhythm after 90 seconds they were given a second dose of the study drug. Resuscitation continued for at least 10 minutes after the study drug was given.…”

Section: Interventionmentioning

confidence: 99%

“…[1][2][3] The primary outcome in BART-1 was return of electrical activity defined as the occurrence of regular QRS complexes at a rate of ≥40 beats/min for at least 60 seconds, within 5 minutes of the study drug and before the administration of further drugs.…”

Section: Outcomes Measuredmentioning

confidence: 99%

“…Population Abu-Laban and colleagues recruited patients >16 years of age with bradyasystole who were unresponsive to intravenous (IV) epinephrine 1 mg and atropine 3 mg. 1 Patients in BART-3 were ≥21 years of age and had to have re-mained in asystolic arrest for 2 minutes after administration of both atropine and epinephrine (doses not specified). 2 Patients in BART-2 were ≥21 years of age with asystole confirmed in more than 1 lead for at least 15 seconds.…”

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confidence: 99%

“…Abu-Laban and colleagues further excluded dialysis patients, patients whose resuscitation was directed by a paramedic student, and those in whom there was a do-not-resuscitate order. 1 Mader and colleagues, in all 3 of their studies, further excluded patients with liver disease or suspected drug overdose. [2][3][4] In each study, patients in the treatment and control groups were similar with respect to demographics and predictors of survival.…”

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confidence: 99%

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