MAGNESIUM IN CARDIAC-ARREST (THE MAGIC TRIAL)

The prognosis of out of hospital cardiac arrest (OHCA) is dismal. Rece nt reports indicate that high dose magnesium may improve survival. A p rospective randomized double blind placebo controlled trial was conduc ted at the emergency department (ED) of Royal Perth Hospital, a Univer sity teaching hospital. Patients with OHCA of cardiac origin received either 5 g MgSO4 or placebo as first line drug therapy. The remainder of their management was standard advanced cardiac life support (ACLS). Study endpoints were: (1) ECG rhythm 2 min after the trial drug; (2) return of spontaneous circulation; (3) survival to leave the ED; (4) s urvival to leave intensive care; and (5) survival to hospital discharg e. Of 67 patients enrolled, 31 received magnesium and 36 placebo. Ther e were no significant differences between groups for all criteria, exc ept that there were significantly more arrests witnessed after arrival of EMS personnel in the magnesium group (11 or 35% vs 4 or 11%). Retu rn of spontaneous circulation occurred in seven (23%) patients receivi ng magnesium and eight (22%) placebo. Four patients ip each group surv ived to leave the ED and one from the magnesium group survived to hosp ital discharge. There were no survivors in the placebo group. In this study, the use of high dose magnesium as first line drug therapy for O HCA was not associated with a significantly improved survival. Early d efibrillation remains the single most important treatment for ventricu lar fibrillation (VF). Further studies are required to evaluate the ro le of magnesium in cardiac and cerebral resuscitation. (C) 1997 Elsevi er Science Ireland Ltd.