Aminophylline for Bradysystolic Cardiac Arrest Refractory to Atropine and Epinephrine.
Fifteen patients with cardiac arrest not responding to epinephrine (2-7 mg) and atropine (2 mg)
were treated with 250 mg aminophylline given as a rapid bolus. In 11 of 15 patients a stable heart
rhythm with measurable blood pressure appeared within 30 seconds of aminophylline injection. This
new approach allowed the discontinuation of closed-chest cardiac massage. Until now asystole has
been treated with higher epinephrine doses. The aminophylline effect may be mediated by its com
petitive antagonism with accumulated endogenous adenosine. Bradycardia and transient asystole are
dose- dependent effects of intravenously administered adenosine. Ten patients died 4 hours to 15
days later; one patient was discharged alive without brain damage. The dramatic response to amino
phylline after prolonged unsuccessful efforts with other drugs indicates that aminophylline might be
used earlier in resuscitation. Ann. Int. Med. 118: 279, Feb. 93.