Adenosine receptor antagonism in refractory asystolic cardiac arrest: results of a human pilot study

Abstract

Primary objective: To determine if adenosine receptor antagonism has any beneficial impact on victims of asystolic cardiac arrest and whether or not it warrants further clinical study as a treatment for cardiac asystole. Materials and methods: A 6-month prospective, randomized, double-blinded, placebo-controlled trial, set in an urban emergency medical services system, in adults with nontraumatic asystolic out-of-hospital cardiac arrest. Patients in whom standard advanced cardiac life support pharmacotherapy failed were randomized to receive placebo or aminophylline, a nonspecific competitive adenosine receptor antagonist. Rhythms were recorded before and after intervention. Results: Twenty-two patients were appropriately entered into the trial. Eight patients served as controls and 14 patients received aminophylline. The groups were similar in all measured parameters except for initial rhythm. None of the patients in the placebo group responded to the intervention. Half of the patients in the treatment group had return of organized cardiac electrical activity. Conclusion: Our results suggest that adenosine receptor antagonism may have a role in the treatment of cardiac asystole. Further clinical studies to validate these findings and clarify the appropriate use of adenosine receptor antagonists in cardiac asystole may be justified.