Magnesium sulfate in the treatment of refractory ventricular fibrillation in the prehospital setting

Objective: To determine if magnesium sulfate (MgSO4) improves outcome in ca rdiac arrest patients initially in ventricular fibrillation (VF). Methods: Randomized, prospective, double blind, placebo-controlled, multicenter preh ospital trial using 2 g of MgSO4. Eligible patients were non-traumatic card iac arrest patients ( greater than or equal to 18 years of age) presenting in VF. The protocol included those patients refractory to three electroshoc ks. Epinephrine and either 2 g of MgSO4 or placebo (normal saline) were the n administered. The primary outcome variable was return of spontaneous circ ulation (ROSC) in the field and a perfusing pulse on arrival at the ED. Sec ondary endpoints included admission to the hospital (ADMT) and hospital dis charge (DISC). IRB approval was obtained at all participating centers. Resu lts: Total 116 patients (58 MgSO4, 58 placebo) were enrolled during the per iod from 4/1992 to 10/96 with 109 available. There were no significant diff erences between the groups in baseline characteristics and times to cardio pulmonary resuscitation (CPR), advanced life support (ALS), and first defib rillation, except for time to study drug administration. There was no signi ficant differences in ROSC (placebo, 18.5%, and MgSO4, 25.5%, P = 0.38), AD MT (placebo rate = 16.7%, MgSO4 = 16.4%, P = 1.0) or DISC (placebo rate = 3 .7%, MgSO4 = 3.6%, P = 1.0). Conclusions: We failed to demonstrate that the administration of 2 g of MgSO4 to prehospital cardiac arrest patients pres enting in VF improves short or long term survival. (C) 2001 Elsevier Scienc e Ireland Ltd. All rights reserved.