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American Heart Association, October 12, 1999 In recent
months manufacturers of bretylium tosylate have been unable to acquire the essential raw
material necessary for production of this adrenergic blocker. As a result, increasing
numbers of ACLS providers have been unable to replace expired and used vials and prefilled
syringes of that drug and have asked if there is an alternative. It should be noted that
bretylium is not the first drug of choice for the treatment of VF or VT. In treating
either arrhythmia, use of bretylium would be preceded at some point by the administration
of a maximum dose of lidocaine. It is further noted that no difference in clinical outcome
or survival is observed in studies comparing lidocaine and bretylium in patients with
out-of-hospital VF. The ECC Committee and its ACLS Subcommittee do not at this time
recommend an alternative to the use of bretylium but are conducting an evaluation of other
possible treatments for refractory malignant ventricular arrhythmias. Until bretylium
supplies are restored or alternatives are identified, ACLS providers should follow all
other protocols described in the American Heart Association's 1992 ECC algorithms for
treatment of VF and VT.
Jerry Potts, PhD
Director of Science
Emergency Cardiovascular Care Programs
American Heart Association, National Center |
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The American Heart Association does not endorse the
coughing procedure being widely publicized on the Internet. The AHA does not teach this as
part of the core curriculum in any of its courses. The reason is that this procedure has
limited potential for clinical application. Theoretically, it can sustain cardiac output
for a short time until someone can administer advanced cardiac life support. This is
possible, however, only if the victim becomes aware that he or she is in cardiac arrest
before losing consciousness. The best strategy is to be aware of the early warning signs
for heart attack and respond to them by calling 911. If an individual driving alone finds
him or herself in the scenario presented in the recently circulated article, he or she
should flag down another motorist for help.
Jerry Potts, PhD
Director of Science
Emergency Cardiovascular Care Programs
American Heart Association, National Center |
