In Reply. —
We appreciate the attention devoted to our report by Drs Lacy and Kostis. However, we differ with them on some of their points. A review of our cases reveals that both patients did indeed fail to respond to conventional therapy. First, we stated that the patients failed to respond to "standard therapy": this includes at least one or more standard doses of epinephrine, as well as other drugs and defibrillation. In case 1, even using the definition of "response" proposed by Drs Lacy and Kostis, the patient's junctional bradycardia present after intubation "deteriorated to fine VF, and 1 mg of epinephrine... was given. Defibrillation... was performed with no change in rhythm"; ie, the patient failed this "round" of conventional therapy. Whether the patient responded (using the definition of Drs Lacy and Kostis) to later rounds of conventional therapy cannot be determined unequivocally.We also note some inconsistency
Koscove E, Paradis N. Resuscitation From Cardiac Arrest Using High-Dose Epinephrine-Reply. JAMA. 1989;261(7):990–991. doi:10.1001/jama.1989.03420070039017
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