Journal of Anaesthesiology Clinical Pharmacology

LETTER TO THE EDITOR
Year
: 2011  |  Volume : 27  |  Issue : 2  |  Page : 289--290

Missing emergency drugs in ICU - A clinician's nightmare!


Aparna Williams, Dootika Liddle 
 Department of Anaesthesiology and Critical Care, Christian Medical College and Hospital, Ludhiana, India

Correspondence Address:
Aparna Williams
Department of Anaesthesiology and Critical Care, Christian Medical College and Hospital, Ludhiana - 141 008, Punjab
India




How to cite this article:
Williams A, Liddle D. Missing emergency drugs in ICU - A clinician's nightmare!.J Anaesthesiol Clin Pharmacol 2011;27:289-290


How to cite this URL:
Williams A, Liddle D. Missing emergency drugs in ICU - A clinician's nightmare!. J Anaesthesiol Clin Pharmacol [serial online] 2011 [cited 2019 Oct 19 ];27:289-290
Available from: http://www.joacp.org/text.asp?2011/27/2/289/81856


Full Text

Sir,

We read with great interest the case report by Singh et al.[1] and congratulate the whole team involved in the resuscitation effort for continuing good quality CPR for 55 minutes, which ensured survival of the patient. It is a commendable feat indeed!

What is worrisome, however, is the unavailability of amiodarone in the intensive care unit (ICU). As anesthesiologists, we frequently come across cardiac dysrrhythmia and the importance of maintaining an emergency drug trolley in areas including the operation theatre, postanesthesia care unit and the ICU cannot be over emphasized.

The incidence of tachyarrhythmias has been reported between 14.9% [2] to 19.7% [3] in the ICUs across the globe. The prognosis of patients with cardiac arrest due to shockable rhythm (pulseless ventricular tachycardia or ventricular fibrillation) has been reported to be better than those with asystole and pulseless electrical activity. As indicated clearly by the authors, amiodarone has replaced lidocaine as the drug of choice for the therapy of pulse less ventricular tachycardia or ventricular fibrillation. [4]

The early administration of amiodarone would not only have decreased the time of CPR with earlier return of spontaneous circulation, but also saved precious time and energy of the CPR team. The time to return of spontaneous circulation is an important determinant of morbidity and mortality in the postcardiac arrest scenario; [5] although in the present case, the patient escaped all neurological injury.

We would again congratulate the team for their untiring resuscitation effort despite unavailability of proper equipment and drugs due to systems failure. We feel that the establishment of an emergency trolley with all necessary drugs and equipment required for resuscitation would go a long way in not only saving lives but also reducing the postcardiac arrest morbidity.

References

1Singh R, Baduni N, Bansal D, Vajifdar H. Effective Cardiopulmonary Resuscitation - How Long Is Not Long Enough? J Anaesth Clin Phamacol 2011;27:125-7.
2Knotzer H, Mayr A, Ulmer H, Lederer W, Schobersberger W, Mutz N, et al. Tachyarrhythmias in a surgical intensive care unit: Case-controlled epidemiologic study. Intensive Care Med 2000;26:908-14.
3Artucio H, Peireira M. Cardiac Arrhythmias in critically ill patients: Epidemiologic study. Crit Care Med 1990;18:1383-8.
4Boudewijn PJ, Michael IM, Jacinta JM, Joel D. Should amiodarone or lidocaine be given to patients who arrest after cardiac surgery and fail to cardiovert from ventricular fibrillation? Interact CardioVasc Thorac Surg 2008;7:1148-51.
5Arrich J, Zeiner A, Sterz F, Janata A, Uray T, Richling N et al. Factors associated with a change in functional outcome between one month and six months after cardiac arrest: A retrospective cohort study. Resuscitation 2009;80:876-80.