A RANDOMIZED, DOUBLE-BLIND COMPARISON OF METHOXAMINE AND EPINEPHRINE IN HUMAN CARDIOPULMONARY ARREST

The beneficial effect of epinephrine has been attributed to its alpha- adrenergic properties. The present study was designed to compare the e ffects of epinephrine and methoxamine in witnessed cardiac arrests. Co nsecutive, witnessed cardiac-arrest victims presenting to the emergenc y room or from the inpatient population of our institution were enroll ed in this study. Patients were randomized to receive either epinephri ne (2 mg bolus followed by 2 mg every 4 min) or methoxamine (40 mg bol us followed after 4 min by 40 mg) in a blind design. Patients were fol lowed prospectively for survival and neurologic outcome. A total of 19 9 patients were randomized into the study, but 54 had to be retrospect ively dropped from analysis for failure to comply with the study proto col. Of the 145 patients remaining, 77 received methoxamine (M) and 68 epinephrine (E). There was no difference in rate of successful resusc itation (42% versus 53%, M versus E, respectively), or in neurologic o utcome as measured by the Glasgow-Pittsburgh Coma Score (GPCS). This s tudy failed to demonstrate any difference in the rate of initial resus citation, survival to discharge from the hospital, or neurologic statu s with methoxamine as opposed to epinephrine in the setting of cardiac arrest.