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Outcomes associated with amiodarone and lidocaine for the treatment of adult in-hospital cardiac arrest with shock-refractory pulseless ventricular tachyarrhythmia

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Title: Outcomes associated with amiodarone and lidocaine for the treatment of adult in-hospital cardiac arrest with shock-refractory pulseless ventricular tachyarrhythmia
Authors: Chih-Hung Wang, Wei-Tien Chang, Chien-Hua Huang, Min-Shan Tsai, Ping-Hsun Yu, Yen-Wen Wu, Yen-Bin Liu, Wen-Jone Chen
Source: Journal of the Formosan Medical Association, Vol 119, Iss 1, Pp 327-334 (2020)
Publisher Information: Elsevier, 2020.
Publication Year: 2020
Collection: LCC:Medicine (General)
Subject Terms: Medicine (General), R5-920
More Details: Background: To determine the association between amiodarone or lidocaine and outcomes in adult in-hospital cardiac arrest (IHCA) with shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). Methods: A retrospective study in a single medical centre was conducted. Patients experiencing an IHCA between 2006 and 2015 were screened. Shock-refractory ventricular tachyarrhythmias were defined as VF/pVT requiring more than one defibrillation attempt. A multivariate logistic regression analysis was used to study the associations between the independent variables and outcomes. Results: A total of 130 patients were included. Among these, 113 patients (86.9%) were administered amiodarone as the first antiarrhythmic agent (amiodarone first) following VF/pVT, and the other patients were administered lidocaine (lidocaine first). The median time to the first defibrillation and first antiarrhythmic drug administration were 2 and 9 min, respectively. The analysis demonstrated that the amiodarone-first group experienced a higher likelihood of terminating the VF/pVT within three shocks (odds ratio: 11.61, 95% confidence interval: 1.34–100.84; p-value = 0.03), as compared with the lidocaine-first group. However, there were no significant differences between the amiodarone- and lidocaine-first groups in sustained return of spontaneous circulation, survival for 24 h, survival, or favourable neurological outcomes at hospital discharge. Conclusion: For patients with IHCA and shock-refractory VF/pVT, the adoption of an amiodarone-first strategy seemed to be associated with the termination of VF/pVT using fewer shocks. Nonetheless, because of the small sample size, additional large-scale studies should be conducted to investigate whether this advantage could be translated into a long-term benefit in survival or neurological outcomes. Keywords: Amiodarone, Arrhythmia, Cardiopulmonary resuscitation, In-hospital cardiac arrest, Lidocaine
Document Type: article
File Description: electronic resource
Language: English
ISSN: 0929-6646
Relation: http://www.sciencedirect.com/science/article/pii/S0929664618307538; https://doaj.org/toc/0929-6646
DOI: 10.1016/j.jfma.2019.05.023
Access URL: https://doaj.org/article/f8f1a7d48f92418f86f25d8abe1f54f2
Accession Number: edsdoj.f8f1a7d48f92418f86f25d8abe1f54f2
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  Data: Outcomes associated with amiodarone and lidocaine for the treatment of adult in-hospital cardiac arrest with shock-refractory pulseless ventricular tachyarrhythmia
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  Data: Journal of the Formosan Medical Association, Vol 119, Iss 1, Pp 327-334 (2020)
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  Data: Background: To determine the association between amiodarone or lidocaine and outcomes in adult in-hospital cardiac arrest (IHCA) with shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). Methods: A retrospective study in a single medical centre was conducted. Patients experiencing an IHCA between 2006 and 2015 were screened. Shock-refractory ventricular tachyarrhythmias were defined as VF/pVT requiring more than one defibrillation attempt. A multivariate logistic regression analysis was used to study the associations between the independent variables and outcomes. Results: A total of 130 patients were included. Among these, 113 patients (86.9%) were administered amiodarone as the first antiarrhythmic agent (amiodarone first) following VF/pVT, and the other patients were administered lidocaine (lidocaine first). The median time to the first defibrillation and first antiarrhythmic drug administration were 2 and 9 min, respectively. The analysis demonstrated that the amiodarone-first group experienced a higher likelihood of terminating the VF/pVT within three shocks (odds ratio: 11.61, 95% confidence interval: 1.34–100.84; p-value = 0.03), as compared with the lidocaine-first group. However, there were no significant differences between the amiodarone- and lidocaine-first groups in sustained return of spontaneous circulation, survival for 24 h, survival, or favourable neurological outcomes at hospital discharge. Conclusion: For patients with IHCA and shock-refractory VF/pVT, the adoption of an amiodarone-first strategy seemed to be associated with the termination of VF/pVT using fewer shocks. Nonetheless, because of the small sample size, additional large-scale studies should be conducted to investigate whether this advantage could be translated into a long-term benefit in survival or neurological outcomes. Keywords: Amiodarone, Arrhythmia, Cardiopulmonary resuscitation, In-hospital cardiac arrest, Lidocaine
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  Data: http://www.sciencedirect.com/science/article/pii/S0929664618307538; https://doaj.org/toc/0929-6646
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