2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Panchal, Ashish R.; Berg, Katherine M.; Kudenchuk, Peter J.; Rios, Marina Del; Hirsch, Karen G.; Link, Mark S.; Kurz, Michael C.; Chan, Paul S.; Cabañas, José G.; Morley, Peter; Hazinski, Mary Fran; Donnino, Michael W.

doi:10.1161/cir.0000000000000613

Cited by 148 publications

(98 citation statements)

References 22 publications

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“…PA, perinatal asphyxia, BP, Blood pressure; NIRS, near-infrared spectrophotometry. Data from the European and American guideline recommendations for time-dependent preductal SpO 2 (20,21).…”

Section: Perinatal Asphyxiamentioning

confidence: 99%

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Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

et al. 2020

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Perinatal asphyxia (PA) is a burdening pathology with high short-term mortality and severe long-term consequences. Its incidence, reaching as high as 10 cases per 1000 live births in the less developed countries, prompts the need for better awareness and prevention of cases at risk, together with management by easily applicable protocols. PA acts first and foremost on the nervous tissue, but also on the heart, by hypoxia and subsequent ischemia-reperfusion injury. Myocardial development at birth is still incomplete and cannot adequately respond to this aggression. Cardiac dysfunction, including low ventricular output, bradycardia, and pulmonary hypertension, complicates the already compromised circulatory status of the newborn with PA. Multiorgan and especially cardiovascular failure seem to play a crucial role in the secondary phase of hypoxic-ischemic encephalopathy (HIE) and its high mortality rate. Hypothermia is an acceptable solution for HIE, but there is a fragile equilibrium between therapeutic gain and cardiovascular instability. A profound understanding of the underlying mechanisms of the nervous and cardiovascular systems and a close collaboration between the bench and bedside specialists in these domains is compulsory. More resources need to be directed toward the prevention of PA and the consecutive decrease of cardiovascular dysfunction. Not much can be done in case of an unexpected acute event that produces PA, where recognition and prompt delivery are the key factors for a positive clinical result. However, the situation is different for high-risk pregnancies or circumstances that make the fetus more vulnerable to asphyxia. Improving the outcome in these cases is possible through careful monitoring, identifying the high-risk pregnancies, and the implementation of novel prenatal strategies. Also, apart from adequately supporting the heart through the acute episode, there is a need for protocols for long-term cardiovascular follow-up. This will increase our recognition of any lasting myocardial damage and will enhance our perspective on the real impact of PA. The goal of this article is to review data on the cardiovascular consequences of PA, in the context of an immature cardiovascular system, discuss the potential contribution of cardiovascular impairment on short and long-term outcomes, and propose further directions of research in this field.

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Section: Perinatal Asphyxiamentioning

confidence: 99%

“…Trying to correct the low saturation of oxygen rapidly can expose the neonatal myocardium to an oxidative stress level that is greater than its handling capacity. Current guidelines suggest following the physiological curve of oxygen saturation rise, as observed in healthy newborn (20,21,36).…”

Section: Ischemia-reperfusion Therapeutic Window Reoxygenation With Rmentioning

confidence: 99%

Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

et al. 2020

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“…Findings with reference to the long-term effects of amiodarone affecting the neurological outcome primarily are not straightforward, although encouraging when compared to other antiarrhythmic agents (Laina et al, 2016;Karlis and Afantenou, 2018). In 2018, American Heart Association (AHA) recommended the further application of amiodarone or lidocaine in the case of VF/pVT due to their short-term positive effects (Panchal et al, 2018). The ROC-ALPS study investigated the short and long-term effects of captisol-based formulation of amiodarone and lidocain in the case of out-of hospital cardiac arrests.…”

Section: Cpc Levelmentioning

confidence: 99%

Handling of Ventricular Fibrillation in the Emergency Setting

et al. 2020

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Ventricular fibrillation (VF) and sudden cardiac death (SCD) are predominantly caused by channelopathies and cardiomyopathies in youngsters and coronary heart disease in the elderly. Temporary factors, e.g., electrolyte imbalance, drug interactions, and substance abuses may play an additive role in arrhythmogenesis. Ectopic automaticity, triggered activity, and reentry mechanisms are known as important electrophysiological substrates for VF determining the antiarrhythmic therapies at the same time. Emergency need for electrical cardioversion is supported by the fact that every minute without defibrillation decreases survival rates by approximately 7%-10%. Thus, early defibrillation is an essential part of antiarrhythmic emergency management. Drug therapy has its relevance rather in the prevention of sudden cardiac death, where early recognition and treatment of the underlying disease has significant importance. Cardioprotective and antiarrhythmic effects of beta blockers in patients predisposed to sudden cardiac death were highlighted in numerous studies, hence nowadays these drugs are considered to be the cornerstones of the prevention and treatment of life-threatening ventricular arrhythmias. Nevertheless, other medical therapies have not been proven to be useful in the prevention of VF. Although amiodarone has shown positive results occasionally, this was not demonstrated to be consistent. Furthermore, the potential proarrhythmic effects of drugs may also limit their applicability. Based on these unfavorable observations we highlight the importance of arrhythmia prevention, where echocardiography, electrocardiography and laboratory testing play a significant role even in the emergency setting. In the following we provide a summary on the latest developments on cardiopulmonary resuscitation, and the evaluation and preventive treatment possibilities of patients with increased susceptibility to VF and SCD.

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“…Lidocaine, an amine derivative of cocaine, is commonly used as a local anaesthetic and as a class 1b antiarrhythmic drug in both paediatric and adult patients . However, it is also used as an anticonvulsant in neonates refractory to 1 or more other antiepileptic drugs (AEDs) such as phenobarbital and midazolam .…”

Section: Introductionmentioning

confidence: 99%

Lidocaine as treatment for neonatal seizures: Evaluation of previously developed population pharmacokinetic models and dosing regimen

Favié

Huitema

Broek

et al. 2020

Brit J Clinical Pharma

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Aims:Lidocaine is used to treat neonatal seizures refractory to other anticonvulsants. It is effective, but also associated with cardiac toxicity. Previous studies have reported on the pharmacokinetics of lidocaine in preterm and term neonates and proposed a dosing regimen for effective and safe lidocaine use. The objective of this study was to evaluate the previously developed pharmacokinetic models and dosing regimen. As a secondary objective, lidocaine effectiveness and safety were assessed. Methods: Data from preterm neonates and (near-)term neonates with and without therapeutic hypothermia receiving lidocaine were included. Pharmacokinetic analyses were performed using non-linear mixed effects modelling. Simulations were performed to evaluate the proposed dosing regimen. Lidocaine was considered effective if no additional anticonvulsant was required and safe if no cardiac adverse events occurred.Results: Data were available for 159 neonates; 50 (31.4%) preterm and 109 term neonates, of whom 49 (30.8%) were treated with therapeutic hypothermia. Lidocaine clearance increased with postmenstrual age by 0.69%/day (95% confidence interval 0.54-0.84%). During therapeutic hypothermia (33.5 C), lidocaine clearance was reduced by 21.8% (7.26%/ C, 95% confidence interval 1.63-11.2%) compared to normothermia (36.5 C). Simulations demonstrated that the proposed dosing regimen leads to adequate average lidocaine plasma concentrations. Effectiveness and safety were assessed in 92 neonates. Overall effectiveness was 53.3% (49/92) and 56.5% (13/23) for neonates receiving the proposed dosing regimen. No cardiac toxicity was observed.A complete list of non-author contributors appears in the Acknowledgements section.The authors confirm that the Principal Investigators for this paper are Timo R. de Haan and Floris Groenendaal and that they had direct clinical responsibility for patients. Conclusion: Lidocaine pharmacokinetics was adequately described across the entire neonatal age range. With the proposed dosing regimen, lidocaine can provide effective and safe treatment for neonatal seizures. K E Y W O R D Sclinical pharmacology, drug utilization, mass spectrometry, modelling and simulation, neonatology, pharmacometrics

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2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Cited by 148 publications

References 22 publications

Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

Getting an Early Start in Understanding Perinatal Asphyxia Impact on the Cardiovascular System

Handling of Ventricular Fibrillation in the Emergency Setting

Lidocaine as treatment for neonatal seizures: Evaluation of previously developed population pharmacokinetic models and dosing regimen

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