Among 218 patients treated for prehospital arrest during an eight-month baseline period prior to addition of
bretylium tosylate to the paramedic protocol in Columbus, 16 (7.3%) were seen with refractory
ventricular fibrillation (RVF). These patients failed to respond to multiple countershocks,
lidocaine,
bicarbonate and
epinephrine, and either were transported in arrest during
cardiopulmonary resuscitation (
CPR)(14) or were pronounced dead at the scene (2). A single patient was eventually resuscitated in and discharged from the hospital. During the subsequent 16 1/2-month experience with
bretylium used only for prehospital RVF, 421 patients with prehospital arrest were seen, 35 of whom (8.3%) had RVF. All but five patients were defibrillated successfully, and 14 (40%) were converted to a rhythm sufficient to obviate
CPR during transportation. Eleven patients (31%) survived to be admitted to the hospital, and eight of 35 (23% vs 1/16 or 6.2% above, P less than .05) were discharged and remained well three to 17 months later.
Bretylium tosylate may provide life-saving
therapy for refractory prehospital
ventricular fibrillation so that survival from an almost uniformly fatal condition is improved. While patients with persistent arrest generally should be transported to the hospital, such patients should not be subjected to the difficulties of
CPR in transit unless they are first given
bretylium if RVF is present.