Bretylium Tosylate and Ventricular Fibrillation in Hypothermia

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To the editor: Ventricular fibrillation in patients with severe hypothermia is often refractory to conventional therapy with core rewarming, correction of hypoxia and acidosis, and lidocaine infusion. The combination of rewarming and infusion of bretylium tosylate may be effective in controlling ventricular fibrillation in such patients.

A 42-year-old homeless man was found comatose on the street on 9 January 1986. On hospitalization, he was in asystole, and cardiopulmonary resuscitation was immediately begun. His initial arterial blood gases showed a PO₂ of 27 torr; PCO₂, 61 torr; pH, 7.13; bicarbonate, 19 meq/L; and serum potassium, 2.6 meq/L. Other electrolytes were within