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Sinha T, Reyaz I, Ibrahim RA, Guntha M, Zin AK, Chapala G, Ravuri MK, Palleti SK. Comparison of the Effects of Lidocaine and Amiodarone on Patients With Cardiac Arrest: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e56037. [PMID: 38623114 PMCID: PMC11017951 DOI: 10.7759/cureus.56037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/17/2024] Open
Abstract
The objective of this study was to compare the impact of amiodarone and lidocaine on survival and neurological outcomes following cardiac arrest. A systematic review of randomized controlled trials (RCTs) as well as cohort and cross-sectional trials was undertaken, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Potential relevant studies were searched in databases, including PubMed, Embase, Cochrane Library, and Web of Science, from the beginning of databases to February 15, 2024. Outcomes assessed in this study were survival to hospital discharge, survival to hospital admission or 24 hours, favorable neurological outcomes, and return of spontaneous circulation (ROSC). A total of seven studies (five observational and two RCTs) were included in this meta-analysis encompassing 19,081 patients with cardiac arrest. Pooled analysis showed no difference between amiodarone and lidocaine in terms of survival to hospital discharge (odds ratio (OR): 0.88, 95% confidence interval (CI): 0.75 to 1.04), ROSC (OR: 0.94, 95% CI: 0.84 to 1.05, p-value: 0.25), favorable neurological outcomes (OR: 0.88, 95% CI: 0.66 to 1.17, p-value: 0.38), and survival to 24 hours (OR: 0.82, 95% CI: 0.55 to 1.21, p-value: 0.31). While lidocaine demonstrated a slight survival advantage, the differences were statistically insignificant. Similarly, no significant variations were observed in ROSC incidence, neurological outcomes, or survival at 24 hours. These findings align with current guidelines but underscore the necessity for further rigorous RCTs to provide conclusive recommendations.
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Affiliation(s)
- Tanya Sinha
- Medical Education, Tribhuvan University, Kirtipur, NPL
| | - Ibrahim Reyaz
- Internal Medicine, Christian Medical College and Hospital, Ludhiana, IND
| | | | | | - Aung K Zin
- Internal Medicine, University of Medicine, Mandalay, Mandalay, MMR
| | - Grahitha Chapala
- Medicine and Surgery, Mkhitar Gosh Armenian Russian International University, Yerevan, ARM
| | - Mohan K Ravuri
- Medicine and Surgery, Mkhitar Gosh Armenian Russian International University, Yerevan, ARM
| | - Sujith K Palleti
- Nephrology, Louisiana State University Health Sciences Center, Shreveport, USA
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Güler S, Könemann H, Wolfes J, Güner F, Ellermann C, Rath B, Frommeyer G, Lange PS, Köbe J, Reinke F, Eckardt L. Lidocaine as an anti-arrhythmic drug: Are there any indications left? Clin Transl Sci 2023; 16:2429-2437. [PMID: 37781966 PMCID: PMC10719458 DOI: 10.1111/cts.13650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
Lidocaine is classified as a class Ib anti-arrhythmic that blocks voltage- and pH-dependent sodium channels. It exhibits well investigated anti-arrhythmic effects and has been the anti-arrhythmic of choice for the treatment of ventricular arrhythmias for several decades. Lidocaine binds primarily to inactivated sodium channels, decreases the action potential duration, and increases the refractory period. It increases the ventricular fibrillatory threshold and can interrupt life-threatening tachycardias caused by re-entrant mechanisms, especially in ischemic tissue. Its use was pushed into the background in the era of amiodarone and modern electric device therapy. Recently, lidocaine has come back into focus for the treatment of acute sustained ventricular tachyarrhythmias. In this brief overview, we review the clinical pharmacology including possible side effects, the historical course, possible indications, and current Guideline recommendations for the use of lidocaine.
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Affiliation(s)
- Sati Güler
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Hilke Könemann
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Julian Wolfes
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Fatih Güner
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Christian Ellermann
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Benjamin Rath
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Gerrit Frommeyer
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | | | - Julia Köbe
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Florian Reinke
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Lars Eckardt
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
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Wang Q, Lin Z, Chen H, Pan B. Comparison the efficacy of amiodarone and lidocaine for cardiac arrest: A network meta-analysis. Medicine (Baltimore) 2023; 102:e33195. [PMID: 37058064 PMCID: PMC10101268 DOI: 10.1097/md.0000000000033195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/14/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND There is no evidence that antiarrhythmic drugs can improve long-term survival or survival with favorable neurological outcomes in cardiac arrest patients. We did this network meta-analysis to comprehensively compare the efficacy of various antiarrhythmic drugs for cardiac arrest patients. METHODS We searched studies from inception until Nov 11, 2022 through PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, and Wanfang database. All studies comparing different antiarrhythmic drugs for cardiac arrest were included in this meta-analysis. Outcomes were survival to hospital discharge in cardiac arrest, survival to hospital admission/24 h and favorable neurological outcome. This network meta-analysis was performed by R software. RESULTS Finally, a total of 9 studies (10,980 patients) were finally included in this network meta-analysis. Amiodarone (odd ratio [OR] 2.28, 95% credibility interval [CrI] 1.61-3.27) and lidocaine (OR 1.53, 95% CrI 1.05-2.25) was superior than placebo in terms of the survival to hospital admission/24 h with statistically significant. Amiodarone (OR 2.19, 95% CrI 1.54-3.14) and lidocaine (OR 1.58, 95% CrI 1.09-2.32) was superior than placebo in terms of the survival to hospital discharge with statistically significant. Amiodarone (OR 2.43, 95% CrI 1.61-3.68) and lidocaine (OR 1.62, 95% CrI 1.04-2.53) was superior than placebo in terms of the favorable neurological outcome with statistically significant. The surface under the cumulative ranking (SUCRA) shows that amiodarone ranked first (SUCRA, 99.6%), lidocaine ranked second (SUCRA, 49.6%), placebo ranked the last (SUCRA, 0.86%). Inverted funnel plot is essentially symmetrical, it is possible that this study has a small sample effect or a small publication bias. CONCLUSIONS Amiodarone had the best effect on both survival to hospital admission, discharge and more favorable neurological outcome. Thus, amiodarone should be listed as first line drug for cardiac arrest. However, the quality of available evidence limits the formation of powerful conclusions regarding the comparative efficacy or safety of amiodarone or lidocaine used to treat cardiac arrest. Higher-quality randomized controlled trials are required for further research in future.
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Affiliation(s)
- Qi Wang
- Department of General Practice, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Zhen Lin
- Department of General Practice Geriatrics, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Hairong Chen
- Department of General Practice, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Biyun Pan
- Department of General Practice, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
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He LM, Zhang A, Xiong B. Effectiveness of Amiodarone in Preventing the Occurrence of Reperfusion Ventricular Fibrillation After the Release of Aortic Cross-Clamp in Open-Heart Surgery Patients: A Meta-Analysis. Front Cardiovasc Med 2022; 9:821938. [PMID: 35187132 PMCID: PMC8854653 DOI: 10.3389/fcvm.2022.821938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the efficiency of amiodarone in preventing the occurrence of reperfusion ventricular fibrillation (RVF) after aortic cross-clamp (ACC) release in patients undergoing open-heart surgery. Methods We searched the Web of Science, Cochrane Library, EMBASE, and PubMed databases through January 2021 for relevant studies addressing the efficacy of amiodarone in preventing RVF after ACC release in patients undergoing cardiac surgery. A complete statistical analysis was performed using RevMan 5.3. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to express the results of dichotomous outcomes using random or fixed-effect models. The chi-square test and I2 test were used to calculate heterogeneity. Results Seven studies (856 enrolled patients; 311 in the amiodarone group, 268 in the lidocaine group, and 277 in the placebo group) were selected for the meta-analysis. The incidence of RVF was significantly decreased in the amiodarone group compared to the placebo group (RR = 0.69, 95%CI: 0.50–0.94, P = 0.02). However, amiodarone and lidocaine did not confer any significant difference (RR = 0.98, 95%CI: 0.61–1.59, P = 0.94). The percentage of patients requiring electric defibrillation counter shocks (DCSs) did not confer any significant difference between patients administered amiodarone and lidocaine or placebo (RR = 1.58, 95%CI: 0.29–8.74, P = 0.60; RR = 0.55, 95%CI: 0.27–1.10, P = 0.09; respectively). Conclusions Amiodarone is more effective than a placebo in preventing RVF after ACC release in cardiac surgery. However, the amiodarone group required the same number of electrical DCSs to terminate RVF as the lidocaine or placebo groups.
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Affiliation(s)
- Li-min He
- Department of Cardiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - An Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Bin Xiong
- Department of Critical Care Medicine, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
- *Correspondence: Bin Xiong
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Zhao H, Fan K, Feng G. Amiodarone and/or lidocaine for cardiac arrest: A Bayesian network meta-analysis. Am J Emerg Med 2020; 38:2185-2193. [DOI: 10.1016/j.ajem.2020.06.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 01/11/2023] Open
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Wang CH, Chang WT, Huang CH, Tsai MS, Yu PH, Wu YW, Liu YB, Chen WJ. Outcomes associated with amiodarone and lidocaine for the treatment of adult in-hospital cardiac arrest with shock-refractory pulseless ventricular tachyarrhythmia. J Formos Med Assoc 2019; 119:327-334. [PMID: 31255419 DOI: 10.1016/j.jfma.2019.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/18/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022] Open
Abstract
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.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Hsun Yu
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nuclear Medicine and Cardiology, Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yen-Bin Liu
- National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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7
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Ali MU, Fitzpatrick-Lewis D, Kenny M, Raina P, Atkins DL, Soar J, Nolan J, Ristagno G, Sherifali D. Effectiveness of antiarrhythmic drugs for shockable cardiac arrest: A systematic review. Resuscitation 2018; 132:63-72. [PMID: 30179691 DOI: 10.1016/j.resuscitation.2018.08.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this systematic review is to provide up-to-date evidence on effectiveness of antiarrhythmic drugs for shockable cardiac arrest to help inform the 2018 International Liaison Committee on Resuscitation Consensus on Science with Treatment Recommendations. METHODS A search was conducted in electronic databases Medline, Embase, and Cochrane Library from inception to August 15, 2017. RESULTS Of the 9371 citations reviewed, a total of 14 RCTs and 17 observational studies met our inclusion criteria for adult population and only 1 observational study for pediatric population. Based on RCT level evidence for adult population, none of the anti-arrhythmic drugs showed any difference in effect compared with placebo, or with other anti-arrhythmic drugs for the critical outcomes of survival to hospital discharge and discharge with good neurological function. For the outcome of return of spontaneous circulation, the results showed a significant increase for lidocaine compared with placebo (RR = 1.16; 95% CI, 1.03-1.29, p = 0.01). CONCLUSION The high level evidence supporting the use of antiarrhythmic drugs during CPR for shockable cardiac arrest is limited and showed no benefit for critical outcomes of survival at hospital discharge, survival with favorable neurological function and long-term survival. Future high quality research is needed to confirm these findings and also to evaluate the role of administering antiarrhythmic drugs in children with shockable cardiac arrest, and in adults immediately after ROSC.
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Affiliation(s)
- Muhammad Usman Ali
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario, L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada
| | - Donna Fitzpatrick-Lewis
- School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre Room HSC-3N25F, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Meghan Kenny
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario, L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada
| | - Parminder Raina
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario, L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada
| | - Dianne L Atkins
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | | | - Jerry Nolan
- University of Bristol and Royal United Hospital, Bath, BA1 3NG, UK
| | - Giuseppe Ristagno
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Diana Sherifali
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario, L8S 4K1, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre Room HSC-3N25F, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
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Antiarrhythmics in Cardiac Arrest: A Systematic Review and Meta-Analysis. Heart Lung Circ 2018; 27:280-290. [DOI: 10.1016/j.hlc.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 06/10/2017] [Accepted: 07/13/2017] [Indexed: 12/15/2022]
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Sato S, Zamami Y, Imai T, Tanaka S, Koyama T, Niimura T, Chuma M, Koga T, Takechi K, Kurata Y, Kondo Y, Izawa-Ishizawa Y, Sendo T, Nakura H, Ishizawa K. Meta-analysis of the efficacies of amiodarone and nifekalant in shock-resistant ventricular fibrillation and pulseless ventricular tachycardia. Sci Rep 2017; 7:12683. [PMID: 28978927 PMCID: PMC5627292 DOI: 10.1038/s41598-017-13073-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/13/2017] [Indexed: 11/09/2022] Open
Abstract
Amiodarone (AMD) and nifekalant (NIF) are used in the treatment of ventricular fibrillation or tachycardia; however, only few studies have been conducted on their efficacies. Therefore, a meta-analysis was conducted. Relevant sources were identified from PubMed, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi. The outcomes were short-term and long-term survival in patients with shock-resistant ventricular fibrillation /pulseless ventricular tachycardia. Thirty-three studies were analysed. The results showed that, compared to the control treatment, AMD did not improve short-term survival (odds ratio (OR): 1.25, 95% confidence interval (CI): 0.91-1.71) or long-term survival (OR: 1.00, 95% CI: 0.63-1.57). However, compared to the control treatment, NIF significantly improved short-term survival (OR: 3.23, 95% CI: 2.21-4.72) and long-term survival (OR: 1.88, 95% CI: 1.36-2.59). No significant difference was observed in short-term survival (OR: 0.85, 95% CI: 0.63-1.15) or long-term survival (OR: 1.25, 95% CI: 0.67-2.31) between AMD- and NIF-treated patients. The results suggest that NIF is beneficial for short-term and long-term survival in shock-resistant ventricular fibrillation/pulseless ventricular tachycardia; however, the efficacy of AMD in either outcome is not clear.
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Affiliation(s)
- Shiho Sato
- Department of Emergency Pharmaceutical Science, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-naka, Okayama, 700-8530, Japan
- South Miyagi Medical Center, Pharmaceutical Department, 38-1 Aza-Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Yoshito Zamami
- Department of Emergency Pharmaceutical Science, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-naka, Okayama, 700-8530, Japan.
- Department of Clinical Pharmacology and Therapeutics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
- Department of Pharmacy, Tokushima University Hospital, 2-50-1 kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Toru Imai
- Department of Pharmacy, Nihon University Itabashi Hospital, 30-1 Oyaguchi-Kami Machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Satoshi Tanaka
- South Miyagi Medical Center, Pharmaceutical Department, 38-1 Aza-Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253, Japan
| | - Toshihiro Koyama
- Department of Clinical Pharmacy, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Takahiro Niimura
- Department of Clinical Pharmacology and Therapeutics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Masayuki Chuma
- Department of Pharmacy, Nihon University Itabashi Hospital, 30-1 Oyaguchi-Kami Machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tadashi Koga
- Drug Safety Research Laboratories, Shin Nippon Biomedical Laboratories, Ltd, 2438 Miyanoura, Kagoshima, 891-1394, Japan
| | - Kenshi Takechi
- Department of Pharmacy, Tokushima University Hospital, 2-50-1 kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yasuko Kurata
- Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yutaka Kondo
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330, Brookline Avenue, Boston, MA, 02215, USA
| | - Yuki Izawa-Ishizawa
- Department of Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Toshiaki Sendo
- Department of Pharmacy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hironori Nakura
- Department of Emergency Pharmaceutical Science, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-naka, Okayama, 700-8530, Japan
| | - Keisuke Ishizawa
- Department of Clinical Pharmacology and Therapeutics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
- Department of Pharmacy, Tokushima University Hospital, 2-50-1 kuramoto-cho, Tokushima, 770-8503, Japan
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Khan SU, Winnicka L, Saleem MA, Rahman H, Rehman N. Amiodarone, lidocaine, magnesium or placebo in shock refractory ventricular arrhythmia: A Bayesian network meta-analysis. Heart Lung 2017; 46:417-424. [PMID: 28958592 DOI: 10.1016/j.hrtlng.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 12/17/2022]
Abstract
Recent evidence challenges, the superiority of amiodarone, compared to other anti-arrhythmic medications, as the agent of choice in pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF). We conducted Bayesian network and traditional meta-analyses to investigate the relative efficacies of amiodarone, lidocaine, magnesium (MgSO4) and placebo as treatments for pulseless VT or VF. Eleven studies [5200 patients, 7 randomized trials (4, 611 patients) and 4 non-randomized studies (589 patients)], were included in this meta-analysis. The search was conducted, from 1981 to February 2017, using MEDLINE, EMBASE and The Cochrane Library. Estimates were reported as odds ratio (OR) with 95% Credible Interval (CrI). Markov chain Monte Carlo (MCMC) modeling was used to estimate the relative ranking probability of each treatment group based on surface under cumulative ranking curve (SUCRA). Bayesian analysis demonstrated that lidocaine had superior effects on survival to hospital discharge, compared to amiodarone (OR, 2.18, 95% Cr.I 1.26-3.13), MgSO4 (OR, 2.03, 95% Cr.I 0.74-4.82) and placebo (OR, 2.42, 95% Cr.I 1.39-3.54). There were no statistical differences among treatment groups regarding survival to hospital admission/24 h (hrs) and return of spontaneous circulation (ROSC). Probability analysis revealed that lidocaine was the most effective therapy for survival to hospital discharge (SUCRA, 97%). We conclude that lidocaine may be the most effective anti-arrhythmic agent for survival to hospital discharge in patients with pulseless VT or VF.
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Affiliation(s)
- Safi U Khan
- Guthrie Clinic/Robert Packer Hospital, Sayre, PA, USA.
| | | | | | - Hammad Rahman
- Guthrie Clinic/Robert Packer Hospital, Sayre, PA, USA
| | - Najeeb Rehman
- Guthrie Clinic/Robert Packer Hospital, Sayre, PA, USA
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11
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Huang CH, Yu PH, Tsai MS, Chuang PY, Wang TD, Chiang CY, Chang WT, Ma MHM, Tang CH, Chen WJ. Acute hospital administration of amiodarone and/or lidocaine in shockable patients presenting with out-of-hospital cardiac arrest: A nationwide cohort study. Int J Cardiol 2016; 227:292-298. [PMID: 27843049 DOI: 10.1016/j.ijcard.2016.11.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/10/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Terminating ventricular fibrillation (VF) or pulseless ventricular tachyarrhythmia (VT) is critical for successful resuscitation of patients with shockable cardiac arrest. In the event of shock-refractory VF, applicable guidelines suggest use of anti-arrhythmic agents. However, subsequent long-term outcomes remain unclear. A nationwide cohort study was therefore launched, examining 1-year survival rates in patients given amiodarone and/or lidocaine for cardiac arrest. METHODS Medical records accruing between years 2004 and 2011 were retrieved from the Taiwan National Health Insurance Research Database (NHIRD) for review. This repository houses all insurance claims data for nearly the entire populace (>99%). Candidates for study included all non-traumatized adults receiving DC shock and cardiopulmonary resuscitation immediately or within 6h of emergency room arrival. Analysis was based on data from emergency rooms and hospitalization. RESULTS One-year survival rates by treatment group were 8.27% (534/6459) for amiodarone, 7.15% (77/1077) for lidocaine, 11.10% (165/1487) for combined amiodarone/lidocaine use, and 3.26% (602/18,440) for use of neither amiodarone nor lidocaine (all, p<0.0001). Relative to those given neither medication, odds ratios for 1-year survival via multiple regression analysis were 1.84 (95% CI: 1.58-2.13; p<0.0001) for amiodarone, 1.88 (95% CI: 1.40-2.53; p<0.0001) for lidocaine, and 2.18 (95% CI: 1.71-2.77; p<0.0001) for dual agent use. CONCLUSIONS In patients with shockable cardiac arrest, 1-year survival rates were improved with association of using amiodarone and/or lidocaine, as opposed to non-treatment. However, outcomes of patients given one or both medications did not differ significantly in intergroup comparisons.
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Affiliation(s)
- Chien-Hua Huang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Hsun Yu
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Ya Chuang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Tzung-Dau Wang
- Department of Internal Medicine (Cardiology), College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Yen Chiang
- Division of Cardiology, Department of Internal Medicine, Cardinal Tien Hospital Yonghe Branch, New Taipei City, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan.
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Sanfilippo F, Corredor C, Santonocito C, Panarello G, Arcadipane A, Ristagno G, Pellis T. Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis. Resuscitation 2016; 107:31-7. [DOI: 10.1016/j.resuscitation.2016.07.235] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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Laina A, Karlis G, Liakos A, Georgiopoulos G, Oikonomou D, Kouskouni E, Chalkias A, Xanthos T. Amiodarone and cardiac arrest: Systematic review and meta-analysis. Int J Cardiol 2016; 221:780-8. [PMID: 27434349 DOI: 10.1016/j.ijcard.2016.07.138] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/08/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The 2015 Guidelines for Resuscitation recommend amiodarone as the antiarrhythmic drug of choice in the treatment of resistant ventricular fibrillation or pulseless ventricular tachycardia. We reviewed the effects of amiodarone on survival and neurological outcome after cardiac arrest. METHODS We systematically searched MEDLINE and Cochrane Library from 1940 to March 2016 without language restrictions. Randomized control trials (RCTs) and observational studies were selected. RESULTS Our search initially identified 1663 studies, 1458 from MEDLINE and 205 from Cochrane Library. Of them, 4 randomized controlled studies and 6 observational studies met the inclusion criteria and were selected for further review. Three randomized studies were included in the meta-analysis. Amiodarone significantly improves survival to hospital admission (OR=1.402, 95% CI: 1.068-1.840, Z=2.43, P=0.015), but neither survival to hospital discharge (RR=0.850, 95% CI: 0.631-1.144, Z=1.07, P=0.284) nor neurological outcome compared to placebo or nifekalant (OR=1.114, 95% CI: 0.923-1.345, Z=1.12, P=0.475). CONCLUSIONS Amiodarone significantly improves survival to hospital admission. However there is no benefit of amiodarone in survival to discharge or neurological outcomes compared to placebo or other antiarrhythmics.
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Affiliation(s)
- Ageliki Laina
- National and Kapodistrian University of Athens, Medical School, M.Sc. "Cardiopulmonary Resuscitation, Athens, Greece; A. Fleming General Hospital, Department of Internal Medicine, Athens, Greece
| | - George Karlis
- National and Kapodistrian University of Athens, Medical School, Evaggelismos Hospital, 1st Department of Intensive Care Medicine, Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Aris Liakos
- Aristotle University of Thessaloniki, Hippokratio General Hospital, Clinical Research and Evidence-Based Medicine Unit, Thessaloniki, Greece
| | - Georgios Georgiopoulos
- National and Kapodistrian University of Athens, Medical School, Department of Clinical Therapeutics, Vascular Laboratory, Athens, Greece
| | - Dimitrios Oikonomou
- A. Fleming General Hospital, Department of Internal Medicine, Athens, Greece
| | - Evangelia Kouskouni
- National and Kapodistrian University of Athens, Medical School, M.Sc. "Cardiopulmonary Resuscitation, Athens, Greece
| | - Athanasios Chalkias
- National and Kapodistrian University of Athens, Medical School, M.Sc. "Cardiopulmonary Resuscitation, Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | - Theodoros Xanthos
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; European University Cyprus, School of Medicine, Nicosia, Cyprus
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Lundin A, Djärv T, Engdahl J, Hollenberg J, Nordberg P, Ravn-Fischer A, Ringh M, Rysz S, Svensson L, Herlitz J, Lundgren P. Drug therapy in cardiac arrest: a review of the literature. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 2:54-75. [DOI: 10.1093/ehjcvp/pvv047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/28/2015] [Indexed: 01/01/2023]
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Oral gabapentin and intradermal injection of lidocaine: is there any role in the treatment of moderate/severe tinnitus? Eur Arch Otorhinolaryngol 2014; 272:2825-30. [DOI: 10.1007/s00405-014-3304-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
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Kudenchuk PJ, Brown SP, Daya M, Morrison LJ, Grunau BE, Rea T, Aufderheide T, Powell J, Leroux B, Vaillancourt C, Larsen J, Wittwer L, Colella MR, Stephens SW, Gamber M, Egan D, Dorian P. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and methodology behind an out-of-hospital cardiac arrest antiarrhythmic drug trial. Am Heart J 2014; 167:653-9.e4. [PMID: 24766974 PMCID: PMC4014351 DOI: 10.1016/j.ahj.2014.02.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/05/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite their wide use, whether antiarrhythmic drugs improve survival after out-of-hospital cardiac arrest (OHCA) is not known. The ROC-ALPS is evaluating the effectiveness of these drugs for OHCA due to shock-refractory ventricular fibrillation or pulseless ventricular tachycardia (VF/VT). METHODS ALPS will randomize 3,000 adults across North America with nontraumatic OHCA, persistent or recurring VF/VT after ≥1 shock, and established vascular access to receive up to 450 mg amiodarone, 180 mg lidocaine, or placebo in the field using a double-blind protocol, along with standard resuscitation measures. The designated target population is all eligible randomized recipients of any dose of ALPS drug whose initial OHCA rhythm was VF/VT. A safety analysis includes all randomized patients regardless of their eligibility, initial arrhythmia, or actual receipt of ALPS drug. The primary outcome of ALPS is survival to hospital discharge; a secondary outcome is functional survival at discharge assessed as a modified Rankin Scale score ≤3. RESULTS The principal aim of ALPS is to determine if survival is improved by amiodarone compared with placebo; secondary aim is to determine if survival is improved by lidocaine vs placebo and/or by amiodarone vs lidocaine. Prioritizing comparisons in this manner acknowledges where differences in outcome are most expected based on existing knowledge. Each aim also represents a clinically relevant comparison between treatments that is worth investigating. CONCLUSIONS Results from ALPS will provide important information about the choice and value of antiarrhythmic therapies for VF/VT arrest with direct implications for resuscitation guidelines and clinical practice.
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Affiliation(s)
- Peter J Kudenchuk
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA; Public Health-Seattle & King County, Seattle, WA.
| | - Siobhan P Brown
- Department of Biostatistics, Clinical Trial Center, University of Washington, Seattle, WA
| | - Mohamud Daya
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Laurie J Morrison
- RESCU, Keenan Research Centre, St Michael's Hospital, Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian E Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom Rea
- Public Health-Seattle & King County, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | | | - Judy Powell
- Department of Biostatistics, Clinical Trial Center, University of Washington, Seattle, WA
| | - Brian Leroux
- Department of Biostatistics, Clinical Trial Center, University of Washington, Seattle, WA
| | - Christian Vaillancourt
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | | | - Lynn Wittwer
- Peace Health Southwest Medical Center, Vancouver, WA
| | - M Riccardo Colella
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee WI
| | | | | | - Debra Egan
- National Heart Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Huang Y, He Q, Yang M, Zhan L. Antiarrhythmia drugs for cardiac arrest: a systemic review and meta-analysis. Crit Care 2013; 17:R173. [PMID: 23938138 PMCID: PMC4056084 DOI: 10.1186/cc12852] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 07/19/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Antiarrhythmia agents have been used in the treatment of cardiac arrest, and we aimed to review the relevant clinical controlled trials to assess the effects of antiarrhythmics during cardiopulmonary resuscitation. METHODS We searched databases including Cochrane Central Register of Controlled Trials; MEDLINE, and EMBASE. Clinical controlled trials that addressed the effects of antiarrhythmics (including amiodarone, lidocaine, magnesium, and other new potassium-channel blockers) on the outcomes of cardiac arrest were included. Data were collected independently by two authors. The risk ratio of each outcome was collected, and meta-analysis was used for data synthesis if appropriate. Heterogeneity was assessed with the χ² test and the I² test. RESULTS Ten randomized controlled trials and seven observational trials were identified. Amiodarone (relative risk (RR), 0.82; 95% confidence interval (CI), 0.54 to 1.24), lidocaine (RR, 2.26; 95% CI, 0.93 to 5.52), magnesium (RR, 0.82; 95% CI, 0.54 to 1.24) and nifekalant were not shown to improve the survival to hospital discharge compared with placebo, but amiodarone, lidocaine, and nifekalant were shown to be beneficial to initial resuscitation, assessed by the rate of return of spontaneous circulation and survival to hospital admission, with amiodarone being superior to lidocaine (RR, 1.28; 95% CI, 0.57 to 2.86) and nifekalant (RR, 0.50; 95% CI, 0.19 to 1.31). Bretylium and sotalol were not shown to be beneficial. CONCLUSIONS Our review suggests that when administered during resuscitation, antiarrhythmia agents might not improve the survival to hospital discharge, but they might be beneficial to initial resuscitation. This is consistent with the AHA 2010 guidelines for resuscitation and cardiovascular emergency, but more studies with good methodologic quality and large numbers of patients are still needed to make further assessment.
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Affiliation(s)
- Yu Huang
- The Third People’s Hospital of Chengdu, The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China
| | - Qing He
- The Third People’s Hospital of Chengdu, The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China
- Department of Respiratory Disease, West China Hospital of Sichuan University, Chengdu, China
- Emergency Department of West China Hospital of Sichuan University, Chengdu 610041, China
| | - Min Yang
- Department of Respiratory Disease, West China Hospital of Sichuan University, Chengdu, China
- Department of Intensive Care Unit, The Second Hospital of Anhui Medical University, Anhui, China
| | - Lei Zhan
- Department of Respiratory Disease, West China Hospital of Sichuan University, Chengdu, China
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Lorentz MN, Vianna BSB. Cardiac Dysrhythmias and Anesthesia. Braz J Anesthesiol 2011; 61:798-813. [DOI: 10.1016/s0034-7094(11)70090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 02/21/2011] [Indexed: 10/26/2022] Open
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Ong MEH, Pellis T, Link MS. The use of antiarrhythmic drugs for adult cardiac arrest: a systematic review. Resuscitation 2011; 82:665-70. [PMID: 21444143 DOI: 10.1016/j.resuscitation.2011.02.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 02/21/2011] [Accepted: 02/23/2011] [Indexed: 11/28/2022]
Abstract
AIMS In adult cardiac arrest, antiarrhythmic drugs are frequently utilized in acute management and legions of medical providers have memorized the dosage and timing of administration. However, data supporting their use is limited and is the focus of this comprehensive review. METHODS Databases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials), Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports. RESULTS Of 185 articles found, only 25 studies met the inclusion criteria for further review. Of these, 9 were randomised controlled trials. Nearly all trials solely evaluated Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF), and excluded Pulseless Electrical Activity (PEA) and asystole. In VT/VF patients, amiodarone improved survival to hospital admission, but not to hospital discharge when compared to lidocaine in two randomized controlled trials. CONCLUSION Amiodarone may be considered for those who have refractory VT/VF, defined as VT/VF not terminated by defibrillation, or VT/VF recurrence in out of hospital cardiac arrest or in-hospital cardiac arrest. There is inadequate evidence to support or refute the use of lidocaine and other antiarrythmic agents in the same settings.
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Affiliation(s)
- Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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Effekt von Amiodaron bei der präklinischen Reanimation. Notf Rett Med 2009. [DOI: 10.1007/s10049-009-1218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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I.V. ropivacaine compared with lidocaine for the treatment of tinnitus. Br J Anaesth 2008; 101:261-5. [DOI: 10.1093/bja/aen137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Overcoming barriers to in-hospital cardiac arrest documentation. Resuscitation 2007; 76:369-75. [PMID: 18023958 DOI: 10.1016/j.resuscitation.2007.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/17/2007] [Accepted: 08/17/2007] [Indexed: 11/21/2022]
Abstract
AIMS (1) To describe the introduction of standardised cardiac arrest documentation to Auckland City Hospital, highlighting how barriers to using the Utstein template were overcome. (2) To determine the adequacy of documentation of cardiac arrest time intervals. METHOD A retrospective audit of cardiac arrest documentation for a 3-year period following the introduction of a standard documentation form. RESULTS There was an initial improvement in use of the template (29% (95%CI 22-37%) to 88% (95%CI 82-92%), p<0.001) after identification of barriers and implementation of tailored strategies. Use of the template declined (77%, 95%CI 69-84%, p=0.023) after the key facilitator left the hospital. Time interval documentation ranged from 66% (95%CI 54-77%) for tracheal intubation to 91% (95%CI 80-93%) for first dose of adrenaline (epinephrine). CONCLUSIONS Designated 'hands-off' senior clinicians were required for accurate documentation of time intervals. Time interval documentation was sub-optimal and further efforts are required to improve this. Transfer of ownership beyond the key facilitator was integral to sustainability of the process. Future reports of in-hospital cardiac arrest outcomes should include baseline information on the adequacy of documentation of time intervals.
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Goldschlager N, Epstein AE, Naccarelli GV, Olshansky B, Singh B, Collard HR, Murphy E. A practical guide for clinicians who treat patients with amiodarone: 2007. Heart Rhythm 2007; 4:1250-9. [PMID: 17765636 DOI: 10.1016/j.hrthm.2007.07.020] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Indexed: 10/23/2022]
Abstract
Amiodarone is commonly used to treat supraventricular and ventricular arrhythmias in various inpatient and outpatient settings. Over- and under-use of amiodarone is common, and data regarding patterns of use are sparse and largely anecdotal. Because of adverse drug reactions, proper use is essential to deriving optimal benefits from the drug with the least risk. This guide updates an earlier version published in 2000, reviews indications for use of amiodarone and recommends strategies to minimize adverse effects. The recommendations included herein are based on the best available data and the collective experience of the member of the writing committee.
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Dager WE, Sanoski CA, Wiggins BS, Tisdale JE. Pharmacotherapy considerations in advanced cardiac life support. Pharmacotherapy 2007; 26:1703-29. [PMID: 17125434 DOI: 10.1592/phco.26.12.1703] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiac arrest and sudden cardiac death remain major causes of mortality. Early intervention has been facilitated by emergency medical response systems and the development of training programs in basic life support and advanced cardiac life support (ACLS). Despite the implementation of these programs, the likelihood of a meaningful outcome in many life-threatening situations remains poor. Pharmacotherapy plays a role in the management of patients with cardiac arrest, with new guidelines for ACLS available in 2005 providing recommendations for the role of specific drug therapies. Epinephrine continues as a recommended means to facilitate defibrillation in patients with pulseless ventricular tachycardia or ventricular fibrillation; vasopressin is an alternative. Amiodarone is the primary antiarrhythmic drug that has been shown to be effective for facilitation of defibrillation in patients with pulseless ventricular tachycardia or fibrillation and is also used for the management of atrial fibrillation and hemodynamically stable ventricular tachycardia. Epinephrine and atropine are the primary agents used for the management of asystole and pulseless electrical activity. Treatment of electrolyte abnormalities, severe hypotension, pulmonary embolism, acute ischemic stroke, and toxicologic emergencies are important components of ACLS management. Selection of the appropriate drug, dose, and timing and route of administration are among the many challenges faced in this setting. Pharmacists who are properly educated and trained regarding the use of pharmacotherapy for patients requiring ACLS can help maximize the likelihood of positive patient outcomes.
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Affiliation(s)
- William E Dager
- University of California-Davis Medical Center, and the School of Medicine, University of California-Davis, Sacramento, California 95817-2201, USA.
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