Successful Resuscitation and Neurologic Recovery from Refractory Ventricular Fibrillation After
Magnesium Sulfate Administration.
A 46-year-old man suffered a witnessed cardiac arrest. Ventricular fibrillation persisted despite
62 minutes of basic and advanced cardiac life support measures which included multiple
defibrillations at 300 to 360 Joules, intubation, IV lidocaine, bretylium, and epinephrine. In the ER, a
central line was started and 4 grams of magnesium sulfate were given as a bolus, followed by
defibrillation at 360 Joules. The patient converted to a junctional rhythm at 100 with a blood pres
sure of 100/80. This rhythm spontaneously converted to a sinus bradycardia at 50. Within 40 min
utes, the patient regained consciousness. This patient regained normal neurologic function. Patients
in whom CPR was begun within 6 minutes and who had total CPR times of greater than 30 minutes
have only a 3% chance of good neurologic recovery. Magnesium may have a beneficial effect in
cerebral resuscitation. It is well known that magnesium is a calcium antagonist and may block
calcium channels in brain tissue. Ann. Emerg. Med. 21:92, Feb. 92.