Am. J. Respir. Crit. Care Med., Vol 152, No. 2, Aug 1995, 519-523.
A randomized, double-blind comparison of methoxamine and epinephrine in human cardiopulmonary arrest
WD Patrick, J Freedman, T McEwen, RB Light, L Ludwig and D Roberts
Department of Critical Care Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
The beneficial effect of epinephrine has been attributed to its alpha-
adrenergic properties. The present study was designed to compare the
effects of epinephrine and methoxamine in witnessed cardiac arrests.
Consecutive, witnessed cardiac-arrest victims presenting to the emergency
room or from the inpatient population of our institution were enrolled in
this study. Patients were randomized to receive either epinephrine (2 mg
bolus followed by 2 mg every 4 min) or methoxamine (40 mg bolus followed
after 4 min by 40 mg) in a blind design. Patients were followed
prospectively for survival and neurologic outcome. A total of 199 patients
were randomized into the study, but 54 had to be retrospectively dropped
from analysis for failure to comply with the study protocol. Of the 145
patients remaining, 77 received methoxamine (M) and 68 epinephrine (E).
There was no difference in rate of successful resuscitation (42% versus
53%, M versus E, respectively), or in neurologic outcome as measured by the
Glasgow-Pittsburgh Coma Score (GPCS). This study failed to demonstrate any
difference in the rate of initial resuscitation, survival to discharge from
the hospital, or neurologic status with methoxamine as opposed to
epinephrine in the setting of cardiac arrest.
