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

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.