Intravenous Aminophylline Research Articles

Comparison between adverse effects of low and usual doses of intravenous aminophylline

Purpose : Some patients develop side effects from theophylline even at low serum concentrations. We designed a prospective study to evaluate the side effects of theophylline. Methods : A Prospective, controlled trial study was conducted. The low-dose group received an intravenous continuous aminophylline dose of 5 mg/kg/day on the first day and subsequently 10 mg/kg/day on the following two days. The usual-dose group received 10 mg/kg/day for three days and the control group received normal saline for three days. Heart rate, respiratory rate, serum concentration of theophylline, and four adverse events (irritability, sleep disturbance, jitter, and vomiting) were checked at the time of admission and at 2, 12, 24, 48, and 72 h after the start of aminophylline infusions. Results : Nine patients out of 37 in the low-dose group and six of 21 in the usual-dose group dropped out because of uncontrolled irritability. The serum concentrations of theophylline in dropouts (3.681.93 ig/mL) and participants (4.472.45 ig/mL) were not significantly different. Irritability was a more frequent side effect in the usual-dose group at 12 h, but there was no difference between the low-dose and usual-dose groups in terms of vomiting, sleep disturbance, and jitter. Most of the severe adverse effects were observed in children below two years of age. Conclusion : Some patients dropped out regardless of the initiating aminophylline dose, especially patients under the age of two years.

BET 3. THE USE OF INTRAVENOUS AMINOPHYLLINE IN ADDITION TO BETA-AGONISTS AND STEROIDS IN ACUTE ASTHMA

BET 3. THE USE OF INTRAVENOUS AMINOPHYLLINE IN ADDITION TO BETA-AGONISTS AND STEROIDS IN ACUTE ASTHMA

Paediatric acute asthma management in Australia and New Zealand: practice patterns in the context of clinical practice guidelines

Objectives:To compare clinical practice guideline (CPG) recommendations and reported physician management of acute paediatric asthma in the 11 largest paediatric emergency departments, all of which have CPGs, in Australia (n...

Aminophylline reversal of prolonged postoperative sedation induced by propofol

Propofol is frequently used for intravenous sedation or anesthesia in ambulatory and office-based anesthesia. Although awakening is usually rapid, there are instances of delayed recovery from propofol anesthesia. It has been reported that aminophylline antagonizes the sedative effects of several anesthetic and analgesic drugs. The case reports presented here demonstrate that intravenous aminophylline effectively reversed prolonged propofol-induced sedation/anesthesia in the postoperative period. There were no side effects or delayed re-sedation after the administration of aminophylline. Our study suggests that aminophylline could be a clinically useful propofol antagonist.

Aminophylline Compatibility with Neonatal Total Parenteral Nutrition

Aminophylline has proven useful for treating renal failure in preterm infants. Previous reports state that aminophylline is incompatible with some neonatal total parenteral nutrition (TPN) solutions. If this is correct, administration of aminophylline doses would be complicated by the need to hold TPN and provide flush solution after each aminophylline dose. Our experience with administering aminophylline over 30 minutes concurrently with TPN was that this was not problematic. We therefore examined the in vitro compatibility of aminophylline and TPN solutions used in our neonates over a 30-minute interval to see if our policy of allowing concurrent mixing of these products was appropriate. TPN solutions (2.5 mL) were mixed with 1 mL of intravenous aminophylline 2.5 mg/mL in a glass vial. Three different TPN solutions used in our NICU were collected for the study, and five samples of each combination were prepared. Samples were watched for 60 minutes to see if precipitation occurred. Although the aminophylline and TPN solutions were not miscible, no turbidity or precipitation was observed. This study supports that aminophylline is physically compatible with neonatal TPN for 60 minutes.

Comparison of Intravenous Terbutaline Versus Normal Saline in Pediatric Patients on Continuous High-Dose Nebulized Albuterol for Status Asthmaticus

To determine if the addition of intravenous terbutaline provides any clinical benefit to children with acute severe asthma already on continuous high-dose nebulized albuterol. We conducted a prospective, randomized, double blind, placebo-controlled trial on pediatric patients with acute severe asthma presenting to a large inner city tertiary children's emergency department. Consecutive patients between 2 and 17 years of age who failed acute asthma management and needed intensive care unit admission underwent informed consent and were enrolled into the study. Patients not requiring intubation were randomized to receive either intravenous terbutaline or intravenous normal saline while on continuous high-dose nebulized albuterol, ipratropium bromide, and systemic corticosteroids. Outcome measures included a clinical asthma severity score, hours on continuous nebulized albuterol, and duration of stay in the pediatric intensive care unit. In addition, electrocardiograms, electrolytes, lactic acid, and troponin I levels were obtained at routine intervals during the first 24 hours after admission. Patients who significantly worsened while enrolled in the study received intravenous aminophylline according to protocol. Forty-nine patients were enrolled in the study. Patients on terbutaline had a mean improvement in the clinical asthma severity score over the first 24 hours of 6.5 points compared with 4.8 points in the placebo group (P = 0.073). Patients on terbutaline spent 38.19 hours on continuous nebulized albuterol compared with their placebo counterparts who spent 51.93 hours (P = 0.25). The length of stay in the PICU was on average 12.95 hours longer for those patients in the placebo group as compared with the terbutaline group (P = 0.345). One patient was removed from the study for a significant cardiac dysrhythmia. This patient was in the terbutaline group and recovered without complications. Troponin I values at 12 hours and 24 hours were elevated in 3 patients each, all within the terbutaline group. No outcome measures demonstrated statistical significance. Outcome measures revealed a trend toward improvement in the terbutaline group. Before recommending routine use of intravenous terbutaline for acute severe asthma, further study to determine safety and efficacy is necessary.

Efficacy and Safety of Intravenous Aminophylline in Children with Acute Exacerbation of Asthma: A Multicenter Randomized Trial

Efficacy and Safety of Intravenous Aminophylline in Children with Acute Exacerbation of Asthma: A Multicenter Randomized Trial

Does the administration of intravenous aminophylline improve survival in adults with bradyasystolic cardiac arrest?

Does the administration of intravenous aminophylline improve survival in adults with bradyasystolic cardiac arrest?

Pretreatment with aminophylline reduces release of Troponin I and neutrophil activation in the myocardium of patients undergoing cardioplegic arrest

Cardioplegic arrest and subsequent reperfusion results in myocardial injury partly related to local inflammation in the heart. It has been proven that aminophylline has numerous anti-inflammatory effects. This study has been designed to evaluate the effects of aminophylline used as a cardioprotective agent for patients undergoing cardiopulmonary bypass (CPB) for valve replacement. Thirty patients undergoing elective valve replacement were randomized to receive either aminophylline (n=15), or normal saline (control n=15). Administration of aminophylline (5mg/kg) was injected intravenously after induction of anesthesia. The cardiac Troponin I (cTnI), myocardial myeloperoxidase (MPO) activity, atrial cyclic AMP, and a coronary sinus neutrophil count were measured before and after cardioplegic arrest. There were no differences between the two groups with regard to clinical variables. The cTnI concentration increased significantly after aortic declamping in both groups. However, it was significantly lower, 8h after aortic declamping, in aminophylline group (1.00+/-0.41 vs 2.37+/-1.35 ng/ml p=0.038). The atrial cAMP was significantly higher before aortic cross-clamping in aminophylline group (42.5+/-6.7 pmol/g tissue vs 30.6+/-12.4 pmol/g tissue p=0.04). In addition, we found that the aminophylline group had a significantly lower MPO after reperfusion (1.50+/-0.58 U/g tissue vs 0.86+/-0.24 U/g tissue p=0.003), and a significantly lower neutrophil count 30 min after aortic declamping (0.68+/-0.11x10(3) cell/ml vs 0.32+/-0.16x10(3) cell/ml, p=0.023). Pretreatment with intravenous aminophylline reduces the subclinical myocardial injury and neutrophil activation in patients undergoing CPB for valve replacement.

Aminophylline in bradyasystolic cardiac arrest: a randomised placebo-controlled trial

Endogenous adenosine might cause or perpetuate bradyasystole. Our aim was to determine whether aminophylline, an adenosine antagonist, increases the rate of return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. In a double-blind trial, we randomly assigned 971 patients older than 16 years with asystole or pulseless electrical activity at fewer than 60 beats per minute, and who were unresponsive to initial treatment with epinephrine and atropine, to receive intravenous aminophylline (250 mg, and an additional 250 mg if necessary) (n=486) or placebo (n=485). The patients were enrolled between January, 2001 and September, 2003, from 1886 people who had had cardiac arrests. Standard resuscitation measures were used for at least 10 mins after the study drug was administered. Analysis was by intention-to-treat. This trial is registered with the ClinicalTrials.gov registry with the number NCT00312273. Baseline characteristics and survival predictors were similar in both groups. The median time from the arrival of the advanced life-support paramedic team to study drug administration was 13 min. The proportion of patients who had an ROSC was 24.5% in the aminophylline group and 23.7% in the placebo group (difference 0.8%; 95% CI -4.6% to 6.2%; p=0.778). The proportion of patients with non-sinus tachyarrhythmias after study drug administration was 34.6% in the aminophylline group and 26.2% in the placebo group (p=0.004). Survival to hospital admission and survival to hospital discharge were not significantly different between the groups. A multivariate logistic regression analysis showed no evidence of a significant subgroup or interactive effect from aminophylline. Although aminophylline increases non-sinus tachyarrhythmias, we noted no evidence that it significantly increases the proportion of patients who achieve ROSC after bradyasystolic cardiac arrest.

A survey of consultant practice: intravenous salbutamol or aminophylline for acute severe childhood asthma and awareness of potential hypokalaemia

British Thoracic Society guidelines recommend intravenous salbutamol or aminophylline for acute severe asthma in children. In the survey reported here, 133 consultant paediatricians completed a questionnaire aimed at evaluating their choice of intravenous bronchodilator for acute severe asthma and their awareness of subsequent hypokalaemia. Of the non-Paediatric Intensive Care Unit (PICU) consultants who responded, 82%, including respiratory paediatricians, reported using aminophylline; in contrast, PICU consultants were significantly more likely to use salbutamol (p=<0.001). There was a lack of awareness that hypokalaemia occurs with aminophylline: 50% of the consultants suggested that hypokalaemia was rare or did not occur. Consultants using intravenous aminophylline were significantly less likely to recheck serum potassium levels than those using intravenous salbutamol (p=0.03). Based on the completed questionnaires, salbutamol infusions are rarely used outside the PICU, and the awareness of potential hypokalaemia following intravenous bronchodilator treatment is variable. It would appear, therefore, that standardised clinical practice is required in order to recognise and treat potential hypokalaemia.

Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators

Background Since the advent of inhaled ß2-agonists, anticholinergic agents and glucocorticoids, the role of aminophylline in paediatric acute asthma has become less clear. There remains some consensus that it is beneficial in children with acute severe asthma, receiving maximised therapy (oxygen, inhaled bronchodilators, and glucocorticoids). Objectives To determine if the addition of intravenous aminophylline produces a beneficial effect in children with acute severe asthma receiving conventional therapy. Search strategy The Cochrane Airways Group register of trials was used to identify relevant studies. The latest search was carried out in December 2004 Selection criteria Randomised-controlled trials comparing intravenous aminophylline with placebo in addition to usual care in children met the inclusion criteria. Data collection and analysis Two reviewers independently assessed studies and extracted data. Disagreement in the selection of trials was resolved by consensus. Attempts were made to contact authors to verify accuracy of data. Main results Seven trials met the inclusion criteria (380 participants). Methodological quality was high. All studies recruited children with acute severe asthma and requiring hospital admission. Six studies sought participants who were unresponsive to nebulised short-acting beta-agonist and administered systemic steroids to study participants. In two studies where some children were able to perform spirometry, baseline FEV1 was between 35 and 45% predicted. The addition of aminophylline to steroids and ß2-agonist significantly improved FEV1% predicted over placebo at 6-8 hours, 12-18 hours and 24 hours. Aminophylline led to a greater improvement in PEF% predicted over placebo at 12-18 hours. There was no significant difference in length of hospital stay, symptoms, frequency of nebulsations and mechanical ventilation rates. There were insufficient data to permit aggregation for oxygenation and duration of supplemental oxygen therapy. Aminophylline led to a three-fold increase in the risk of vomiting. There was no significant difference between treatment groups with regard to hypokalaemia, headaches, tremour, seizures, arrhythmias and deaths. Authors' conclusions In children with a severe asthma exacerbation, the addition of intravenous aminophylline to ß2-agonists and glucocorticoids (with or without anticholinergics) improves lung function within 6 hours of treatment. However there is no apparent reduction in symptoms, number of nebulised treatment and length of hospital stay. There is insufficient evidence to assess the impact on oxygenation, PICU admission and mechanical ventilation. Aminophylline is associated with a significant increased risk of vomiting. PLAIN LANGUAGE SUMMARY Acute asthma is a common paediatric emergency prevalent in many countries. Treatment aims to reverse asthma by opening up the airways and targeting the underlying inflammation of the airways. Beta-agonists, anticholinergic agents and glucocorticoids are currently the most commonly used strategies. In the past, aminophylline has been extensively used for the management of acute asthma, despite side effects. However, its use has declined with the availability of effective inhaled bronchodilators and glucocorticoids. The purpose of this review was to assess whether the use of intravenous aminophylline in children receiving maximised inhaled bronchodilators and glucocorticoids produced additional beneficial effects. We identified a small number of good quality trials which compared aminophylline with placebo in children given inhaled bronchodilators and glucocorticoid therapy. This review found evidence that children treated with aminophylline had a greater improvement in lung function than children treated with placebo, when both groups received inhaled bronchodilators and steroids and they responded incompletely to these initial therapies. However, aminophylline use also resulted in greater risk of vomiting. Aminophylline use in children may be appropriate if children have a role in severe acute exacerbations of asthma where response to maximised therapy (inhaled bronchodilators and glucocorticoids) is poor. These results are based on small numbers and further work in this area is required. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Commentary on ‘Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators’

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Mitta A, Bassler D, Goodman K, Lasserson TJ, Ducharme FM. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. The Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001276. DOI: 10.1002/14651858.CD001276.pub2. Copyright © 2006 John Wiley & Sons, Ltd.

Summary of ‘Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators’

This is a summary of a Cochrane review, published in this issue of EBCH, first published as: Mitta A, Bassler D, Goodman K, Lasserson TJ, Ducharme FM. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. The Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001276. DOI: 10.1002/14651858.CD001276.pub2. Copyright © 2006 John Wiley & Sons, Ltd.

Sinus arrest during adenosine stress testing in liver transplant recipients with graft failure: Three case reports and a review of the literature

Nuclear stress imaging is used frequently to evaluate patients with end-stage liver disease who are being considered for orthotopic liver transplantation. We present three patients who, following graft failure, developed sinus arrest during adenosine stress testing performed in anticipation of repeat liver transplantation. All had undergone uneventful adenosine stress imaging prior to initial transplantation. The mechanisms of action, pharmacokinetics, and pharmacodynamics of adenosine are reviewed, and possible reasons for this phenomenon are discussed. Finally, cautions regarding the use of adenosine and treatment of adenosine-induced sinoatrial and atrioventricular block are reviewed. Adenosine should be used with caution in patients following orthotopic liver transplantation due to an increased risk of sinus arrest. Should sinus arrest or atrioventricular block occur, it appears to respond readily to cessation of adenosine infusion and intravenous aminophylline with no significant sequelae.

Intravenous aminophylline provides no additional renal protection in patient with severe atherosclerotic renal artery stenosis treated by delicate percutaneous renal intervention

Background Clinical trials on contrast-induced nephropathy (CIN) prevention with different approaches generated various results. In this study, we investigated whether intravenous aminophylline preceding percutaneous transluminal renal artery stenting (PTRS) might provide better renal protection. Methods Patients with severe atherosclerotic renal artery stenosis and undergoing PTRS were prospectively studied. Intravenous aminophylline 250 mg was administered 30 min before PTRS. Results The aminophylline group included 15 patients (mean age, 68 ± 4 years) and the case-matched control group consisted of another 15 patients (mean age, 71 ± 2 years). After a mean follow-up of 5–6 months, both groups showed similar serum creatinine (1.7 ± 0.2 vs. 1.6 ± 0.1 mg/dl, P = NS), BUN (20.0 ± 3.0 vs. 24.0 ± 3.0 mg/dl, P = NS), fall in systolic (− 15 ± 13 vs. − 11 ± 3 mm Hg, P = NS) and diastolic BP (− 2 ± 4 vs. − 6 ± 5 mm Hg, P = NS). The incidence of post-operative renal deterioration was 6.7% in the study group and none in the control group. Conclusion Pre-treatment intravenous aminophylline provides no additional renal protective effect in delicately practiced PTRS.

An unexpected response to intravenous hydrocortisone succinate in an asthmatic patient

A 39-year-old female nonsmoker was admitted to hospital with worsening cough, breathlessness, wheeze and purulent sputum production. She had a 17-year history of poorly controlled atopic asthma and in the preceding few years had required numerous courses of oral – but never parenteral – corticosteroids. Initial treatment consisted of oral prednisolone, nebulized bronchodilators, intravenous aminophylline and broad spectrum antibiotics. Two days later due to vomiting, impaired peak expiratory flow and persistent wheeze, she was prescribed parental corticosteroids. Minutes after a 100-ml saline infusion containing 200 mg intravenous hydrocortisone succinate (SoluCortef®) was commenced, she developed widespread erythema, tachycardia and orofacial oedema. Despite stopping the infusion and administering 10 mg intravenous chlorpheniramine, she complained of marked breathless and wheeze in conjunction with more widespread erythema. The patient was given intramuscular adrenaline (0.5 ml of 1 : 1000), which promptly relieved symptoms. Sensitivity reactions and bronchospasm to intravenous corticosteroids containing succinate have previously been documented in both male and female asthmatics [1–3]. Although considered rare, the true extent of such reactions is unknown and no uniform mechanism has been identified [4]. Phosphate-containing corticosteroid preparations are not considered to be associated with allergic reactions [1], but can be associated with troublesome perineal pain in women (gro.fnb.www//:ptth). This case is an important reminder to clinicians and nursing staff, that some patients can develop allergic reactions to parenteral corticosteroids containing succinate. As evidenced by our case, this can occur after even a small quantity is given by slow infusion. Whether in the future all corticosteroids should be formulated with a phosphate ester – albeit with a greater risk of developing perineal pain in women – is uncertain. With greater use of the ‘yellow card’ alert system in the British National Formulary (BNF), the frequency of both perineal pain and allergic reactions to phosphate and succinate-containing corticosteroids, respectively, may become apparent. Moreover, perhaps this uncommon adverse effect should be highlighted in future editions of the BNF.

Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators.

Since the advent of inhaled beta2-agonists, anticholinergic agents and glucocorticoids, the role of aminophylline in paediatric acute asthma has become less clear. There remains some consensus that it is beneficial in children with acute severe asthma, receiving maximised therapy (oxygen, inhaled bronchodilators, and glucocorticoids). To determine if the addition of intravenous aminophylline produces a beneficial effect in children with acute severe asthma receiving conventional therapy. The Cochrane Airways Group register of trials was used to identify relevant studies. The latest search was carried out in December 2004 Randomised-controlled trials comparing intravenous aminophylline with placebo in addition to usual care in children met the inclusion criteria. Two reviewers independently assessed studies and extracted data. Disagreement in the selection of trials was resolved by consensus. Attempts were made to contact authors to verify accuracy of data. Seven trials met the inclusion criteria (380 participants). Methodological quality was high. All studies recruited children with acute severe asthma and requiring hospital admission. Six studies sought participants who were unresponsive to nebulised short-acting beta-agonist and administered systemic steroids to study participants. In two studies where some children were able to perform spirometry, baseline FEV1 was between 35 and 45% predicted. The addition of aminophylline to steroids and beta2-agonist significantly improved FEV1% predicted over placebo at 6-8 hours, 12-18 hours and 24 hours. Aminophylline led to a greater improvement in PEF% predicted over placebo at 12-18 hours. There was no significant difference in length of hospital stay, symptoms, frequency of nebulsations and mechanical ventilation rates. There were insufficient data to permit aggregation for oxygenation and duration of supplemental oxygen therapy. Aminophylline led to a three-fold increase in the risk of vomiting. There was no significant difference between treatment groups with regard to hypokalaemia, headaches, tremour, seizures, arrhythmias and deaths. In children with a severe asthma exacerbation, the addition of intravenous aminophylline to beta2-agonists and glucocorticoids (with or without anticholinergics) improves lung function within 6 hours of treatment. However there is no apparent reduction in symptoms, number of nebulised treatment and length of hospital stay. There is insufficient evidence to assess the impact on oxygenation, PICU admission and mechanical ventilation. Aminophylline is associated with a significant increased risk of vomiting.

Implementing evidence‐based guidelines: inpatient management of chronic obstructive pulmonary disease

Evidence-based guidelines exist to guide inpatient management of chronic obstructive pulmonary disease (COPD) exacerbations, but we do not know how well these recommendations are adhered to. The aims of this study were: (i) to examine concordance with evidence based guidelines for inpatient management of COPD and (ii)to address deficiencies in compliance with guidelines by feedback of audit results and distribution of an education package. Retrospective chart reviews were performed using a data collection tool based on current guidelines. Forty-nine consecutive COPD admissions were audited, and results presented to medical staff. An education package was distributed directly after the presentation. One month later,35 consecutive separations were reviewed. Concordance with recommendations supported by the highest level of evidence was calculated. Data were complete for 84 cases. Concordance rates ranged from 0 to 100%. Apart from initiation of systemic steroids (80-83%)and avoidance of intravenous aminophylline (100%),concordance rates were less than 60%. The only significant improvement post-intervention was for steroid duration (10 vs 29%,95% confidence interval for difference (-36.2, -1.8)). Recommendations for steroid initiation and avoidance of aminophylline are well adhered to. Concordance rates for other recommendations were generally less than 60%. Concordance with recommendations for steroid duration was significantly improved by our intervention. The findings suggest that to facilitate evidence-based practice, alternative interventions should be evaluated.

A Randomized Controlled Trial of Intravenous Aminophylline for Atropine‐resistant Out‐of‐hospital Asystolic Cardiac Arrest

Abstract Objectives: Myocardial ischemia, during cardiopulmonary arrest, can lead to atropine‐resistant bradyasystole from interstitial accumulation of endogenous adenosine. Aminophylline is a nonspecific adenosine receptor antagonist capable of reversing ischemia‐induced bradyasystole in a variety of settings. The hypothesis of this study was that aminophylline improves the rate of return of spontaneous circulation (ROSC) in atropine‐resistant asystolic out‐of‐hospital cardiac arrest when used early in the resuscitation effort. Methods: This was a prospective, randomized, double‐blinded, placebo‐controlled trial set in an urban emergency medical services system serving a population of 250,000. All non‐pregnant, normothermic adults suffering nontraumatic out‐of‐hospital cardiac arrest (February 1999 to August 2000) with asystole were eligible. Patients remaining in asystole after initial doses of epinephrine and atropine received either aminophylline 250 mg or matching placebo as a bolus injection through a peripheral intravenous line. All other aspects of the attempted resuscitation proceeded in accordance with standard Advanced Cardiac Life Support (ACLS) guidelines. A sample size of 102 patients was calculated to yield a power of 80% to show an absolute improvement of 25% in ROSC. The aminophylline and control groups were compared by calculating 95% confidence intervals (95% CIs) and the data were modeled using logistic regression. Results: The investigators enrolled 112 consecutive patients. One subject was dropped prior to analysis because of missing data. Data for 111 patients were analyzed on an intention‐to‐treat basis. Baseline characteristics were similar for the two groups. Comparing the control and aminophylline groups, ROSC was achieved in 15.6% (95% CI = 6% to 29%) and 22.7% (95% CI = 13% to 35%), while reversal of asystole occurred in 26.7% (95% CI = 15% to 42%) and 40.9% (95% CI = 29% to 54%), respectively. Group allocation had an odds ratio of 1.8 (95% CI = 0.6 to 5.3) for ROSC. Witnessed arrest was an independent predictor of outcome with an odds ratio of 3.8 (95% CI = 1.3 to 11.2). Conclusions: Addition of aminophylline appears to be a promising new intervention in the ACLS treatment of atropine‐resistant asystolic out‐of‐hospital cardiac arrest.