Resuscitation from prolonged cardiac arrest with high-dose intravenous magnesium sulfate

Craddock, Lane D.; Miller, Brian; Clifton, Guy L.; Krumbach, Barbara; Pluss, William

doi:10.1016/0736-4679(91)90220-a

Cited by 23 publications

(5 citation statements)

References 29 publications

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“…The presence of a low plasma magnesium concentration was associated with poor prognosis in cardiac arrest patients in 3 studies (LOE 5). 724 -726 The use of magnesium in cardiac arrest was supported by 5 case series (LOE 4) [727][728][729][730][731] ; however, 5 RCTs (LOE 1) 219 -222,732 and a systematic review (LOE 1) 733 found no benefit from the use of magnesium in cardiac arrest.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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Section: Consensus On Sciencementioning

confidence: 99%

Part 8: Advanced Life Support

Morrison¹,

Deakin²,

Morley³

et al. 2010

Circulation

411

169

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“…A number of case reports have suggested a beneficial outcome in treating patients with prolonged refractory VF. 9 10 Three randomised studies have been published to date, all suggesting no benefical outcome. [11][12][13] However, each study suffered from significant limitations, making the conclusions drawn open to question and leaving magnesium's exact role as an antiarrhythmic agent unanswered.…”

mentioning

confidence: 99%

A randomised trial to investigate the efficacy of magnesium sulphate for refractory ventricular fibrillation

Hassan

Jagger²,

Barnett³

2002

Emergency Medicine Journal

105

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Background: Ventricular fibrillation (VF) remains the most salvageable rhythm in patients suffering a cardiopulmonary arrest (CA). However, outcome remains poor if there is no response to initial defibrillation. Some evidence suggests that intravenous magnesium may prove to be an effective antiarrhythmic agent in such circumstances. Study hypothesis: Intravenous magnesium sulphate given early in the resuscitation phase for patients in refractory VF (VF after 3 DC shocks) or recurring VF will significantly improve their outcome, defined as a return of spontaneous circulation (ROSC) and discharge from hospital alive. Design: A randomised, double blind, placebo controlled trial. Pre-defined primary and secondary endpoints were ROSC at the scene or in accident and emergency (A&E) and discharge from hospital alive respectively. Setting, participants, and intervention: Patients in CA with refractory or recurrent VF treated in the prehospital phase by the county emergency medical services and/or in the A&E department. One hundred and five patients with refractory VF were recruited over a 15 month period and randomised to receive either 2-4 g of magnesium sulphate or placebo intravenously. Results: Fifty two patients received magnesium treatment and 53 received placebo. The two groups were matched for most parameters including sex, response time for arrival at scene and airway interventions. There were no significant differences between magnesium and placebo for ROSC at the scene or A&E (17% v 13%). The 4% difference had 95% confidence intervals (CI) ranging from −10% to +18%. For patients being alive to discharge from hospital (4% v 2%) the difference was 2% (95% CI -7% to +11%). After adjustment for potential confounding variables (age, witnessed arrest, bystander cardiopulmonary resuscitation and system response time), the odds ratio (95% CI) for ROSC in patients treated with magnesium as compared with placebo was 1.69 (0.54 to 5.30). Conclusion: Intravenous magnesium given early in patients suffering CA with refractory or recurrent VF did not significantly improve the proportion with a ROSC or who were discharged from hospital alive.

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“…While such an improvement may seem overly optimistic, it was based on the outcomes from some case reports. [7][8][9] Assuming an improvement of 10% in ROSC with magnesium therapy, 700 patients in each group would be required to detect the difference, and thus the study was underpowered. If a sample size estimation was based on survival to hospital discharge, the study was powered to detect a 10% difference (200 patients required per group), but was underpowered for a 5% change (686 patients required per group).…”

Section: Discussionmentioning

confidence: 99%

“…5 These physiological effects have led to the use of magnesium in the treatment of cardiac dysrhythmias, particularly in torsades de pointes. 6 Three case reports showed magnesium benefited patients with refractory ventricular fibrillation, [7][8][9] and one randomised controlled trial (RCT) demonstrated magnesium could increase return of spontaneous circulation (ROSC) and survival to hospital discharge in cardiac arrest patients with ventricular fibrillation, 10 b u t s o m e RC Ts f o u n d n o b e n e f i t d u r i n g cardiopulmonary resuscitation (CPR) in cardiac arrest patients. [11][12][13][14][15] This systematic review aimed to assess the effects of magnesium sulfate on ROSC and survival to hospital discharge in cardiac arrest patients using a metaanalytical approach based on the published RCTs.…”

Section: Introductionmentioning

confidence: 99%