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Amiodarone Improves Survival after Cardiac Arrest

Although antiarrhythmic drugs are the standard of care in cardiac arrest, there is little scientific evidence demonstrating their benefit. This placebo-controlled, randomized, double-blind study evaluated amiodarone as the initial antiarrhythmic agent for patients in ventricular fibrillation or pulseless ventricular tachycardia. This study was supported by the drug manufacturer.

Over a 25-month period, 3,954 patients were treated for out-of-hospital cardiac arrest in Seattle and King County; 667 met the study criteria of ventricular fibrillation or pulseless ventricular tachycardia after three defibrillation attempts. Enrolled patients received 1 mg of epinephrine intravenously followed by either 300 mg of amiodarone or placebo, plus additional antiarrhythmic drugs as indicated. Patients who received amiodarone were more likely to survive to hospital admission (108 of 246 [44%] vs. 89 of 258 [34%], p=0.03), but they were also more likely to have hypotension (59% vs. 48%, p=0.04) and bradycardia (41% vs. 25%, p=0.004). The trial did not have sufficient power to detect differences in survival to hospital discharge.

Comment: Seattle and King County are known to have a high survival rate for victims of out-of-hospital cardiac arrest. Overall survival to hospital admission in this analysis was a remarkable 39%, a rate unlikely to be reproduced in other locations. The benefit of amiodarone as the initial antiarrhythmic agent may make sense, but further study is needed. Future studies should include systems with more typical survival rates and should determine survival to hospital discharge.

— JG Adams

Published in Journal Watch Emergency Medicine November 1, 1999

Citation(s):

Kudenchuk PJ. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med 1999 Sep 16 341 871-878.

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