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• W2076164555 abstract "Authors' reply SIR—We wrestled with the same questions raised by Tajek Hassan and David Barnett and attempted to address them in our study design and the manuscript discussion. We chose not to limit our study to the possible antiarrhythmic effect of magnesium in ventricular tachyarrhythmias. It is not known whether the (purported) benefit of magnesium is mediated through an antiarrhythmic effect, by preventing reperfusion injury, by mild calcium-channel blockade reducing the risk of collapse of intramural coronary arterioles, or by reducing the risk of myocardial and neuronal brain necrosis through the inhibition of inhibiting calcium entry into the ischaemic cell. Our results suggest magnesium was more effective in patients with an initial rhythm other than ventricular tachycardia or fibrillation. In the ISIS-4 trial1ISIS-4 (Fourth International Study of Infarct Survival) Collaborative GroupISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58 050 patients with suspected acute myocardial infarction.Lancet. 1995; 345: 669-685Summary PubMed Scopus (1493) Google Scholar there was no difference in the incidence of cardiac arrest (6·7%) between the magnesium and placebo groups. Although mortality was reduced in the magnesium group in the LIMIT-2 trial,2Woods KL Fletcher S Roffe C Haider Y Intravenous magnesium sulphate in suspected acute myocardial infarction: results of the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2).Lancet. 1992; 339: 1553-1558Summary PubMed Scopus (478) Google Scholar there was no difference in the frequency of tachyarrhythmias. Furthermore, the difficulty of rhythm analysis in cardiac arrest cannot be overstated. Ventricular fibrillation may be mistaken as asystole; since many rhythms during cardiac arrest are transitory, the rhythm present on initial monitoring may differ from that in cardiac arrest. The protocol directed that the study drug should be administered as soon as possible without interfering with delivery of standard advanced cardiac life support. The difficulty in timing of delivery was compounded by the lack of synchronisation of watches among the hospital operators, nurses, and physicians. We were also disappointed by the apparent delay in delivery of study drug; however, the time to treatment was similar to previous trials. Finally, the optimum dose of magnesium is disputable. Our choice was based on the results of previous magnesium trials, the absence of informed consent, and the principle of “first, do no harm”. Magnesium in in-hospital cardiac arrestMark Thel and colleagues (Nov 1, p 1272)1 report that magnesium is of negligible benefit in in-hospital cardiac arrest. Such randomised, placebo-controlled studies are few and far between in this area, so clinicians may be influenced by this finding. However, we would like to question the validity of Thel and co-workers' conclusions. Full-Text PDF" @default.
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• W2076164555 title "Magnesium in in-hospital cardiac arrest" @default.
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• W2076164555 doi "https://doi.org/10.1016/s0140-6736(05)78391-4" @default.
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