Impact of early intravenous amiodarone administration on neurological outcome in refractory ventricular fibrillation: retrospective analysis of prospectively collected prehospital data

Lee, Dong Hoon; Kim, Yu Jin; Kim, Gi Woon; Lee, Choung Ah; Moon, Hyung Jun; Oh, Jaehoon; Yang, Hae Chul; Choi, Heeseung; Oh, Young Taeck; Park, Seung Min

doi:10.1186/s13049-019-0688-1

Cited by 12 publications

(11 citation statements)

References 26 publications

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“…We estimated the optimal time window for amiodarone administration, in terms of discriminating the likelihood of survival, was less than 23 min. Our results are similar to the 20 min cut‐off reported in Lee et al 10 . in a small cohort of patients in South Korea.…”

Section: Discussionsupporting

confidence: 92%

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Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation

Wissa

Schultz

Wilson

et al. 2021

Emerg Medicine Australasia

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Objective International guidelines recommend amiodarone for out‐of‐hospital cardiac arrest (OHCA) in refractory ventricular fibrillation (VF). While early appropriate interventions have been shown to improve OHCA survival, the association between time to amiodarone and survival remains to be established. Methods Included were adult OHCA in refractory VF, between January 2015 and December 2019, who received a resuscitation attempt with amiodarone from Queensland Ambulance Service paramedics. Patient characteristics and survival outcomes were described. Factors associated with survival were investigated, with a focus on time from arrest to amiodarone administration. Optimal time window for amiodarone administration was determined, and factors influencing whether amiodarone was given within the optimal time window were examined. Results A total of 502 patients were included. The average (range) time from arrest to amiodarone was 25 (4–83) min. Time to amiodarone was negatively associated with survival (adjusted odds ratio 0.93 for event survival; 95% confidence interval 0.89–0.97). The optimal time window for amiodarone was within 23 min following arrest. Patients receiving amiodarone within the optimal time had significantly better survival than those receiving it outside this window (event survival 38.3% vs 20.6%, P < 0.001; discharge survival 25.5% vs 9.7%, P < 0.001; 30‐day survival 25.1% vs 9.7%, P < 0.001). Paramedic response time (adjusted odds ratio 0.96; 95% confidence interval 0.92–0.99) and time from arrest to intravenous access (0.71; 0.67–0.76) were independent factors determining whether patients received amiodarone within the optimal time. Conclusions Earlier amiodarone administration was associated with improved survival. Strategies aimed at reducing delay to amiodarone administration have the potential to improve outcome.

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Section: Discussionsupporting

confidence: 92%

“…However, such literature regarding the administration time of antiarrhythmic agents remains scarce. To date, Lee et al 10 . is the only study that examined the relationship between time to amiodarone administration and outcome in refractory VF patients.…”

Section: Introductionmentioning

confidence: 99%

Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation

Wissa

Schultz

Wilson

et al. 2021

Emerg Medicine Australasia

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“…This recommendation is in accordance with the 2018 AHA guidelines, which state that amiodarone is beneficial at the early onset of disease. (27). The results of this analysis are also by previous research that indicated that amiodarone might be related to a lower long-term ventricular defibrillation threshold (6,28,29), suggesting that amiodarone has beneficial effects on malignant arrhythmia.…”

Section: Discussionsupporting

confidence: 62%

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

Zhang

Xiong

2022

Front. Cardiovasc. Med.

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ObjectiveTo 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.MethodsWe 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.ResultsSeven 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).ConclusionsAmiodarone 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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“…Similar data apply to amiodarone. There was no increase in survival outcomes until a person was discharged from hospital, but the effect of short-term improvement in condition was obtained [ 39 ]. It should be noted here that the drug delivery algorithm was divided depending on the mechanism of cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of the Effectiveness of Performing Advanced Resuscitation Procedures Undertaken by Two- and Three- Person Basic Medical Rescue Teams in Adults under Simulated Conditions

Krzyżanowski

Ślęzak

Dąbrowski

et al. 2021

IJERPH

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(1) Objective: Paramedics as a profession are a pillar of the State Medical Rescue system. The basic difference between a specialist and a basic team is the composition of members. The aim of the study was to benchmark the effectiveness of performing advanced resuscitation procedures undertaken by two- and three-person basic emergency medical teams in adults under simulated conditions. (2) Design: The research was observational. 200 two- and three-people basic emergency medical teams were analyzed during advanced resuscitation procedures, ALS (Advanced Life Support) in adults under simulated conditions. (3) Method: The study was carried out among professionally active and certified paramedics. It lasted over two years. The study took place under simulated conditions using prepared scenarios. (4) Results: In total, 463 people took part in the study. The analysis of the survey results indicates that the efficiency of three-person teams is superior to the activities performed by two-person teams. Three-person teams were quicker to perform rescue actions than two-person teams. The two-person teams were much quicker to assess the condition of victims than the three-person teams. The three-person teams were more likely to check an open airway. The three-person teams were more efficient in assessing the heart rhythm and current condition of victims. It was demonstrated that three-person teams were more effective during electrotherapy. The analysis demonstrated that three-person teams were significantly faster and more efficient in chest compressions. Three-person teams were less likely to use emergency airway techniques than two-person teams. The results indicate that three-person teams administered the first dose of adrenaline significantly faster than two-person teams. For the “call for help”, the three-person teams were found to be more effective. (5) Conclusion: Paramedics in three-person teams work more effectively, make a proper assessment of heart rhythm and monitor when taking advanced actions. The quality of ventilation and BLS in both groups studied is insufficient. Numerous errors have been observed in two-person teams during pharmacotherapy.

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Impact of early intravenous amiodarone administration on neurological outcome in refractory ventricular fibrillation: retrospective analysis of prospectively collected prehospital data

Cited by 12 publications

References 26 publications

Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation

Time to amiodarone administration and survival outcomes in refractory ventricular fibrillation

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

Comparative Analysis of the Effectiveness of Performing Advanced Resuscitation Procedures Undertaken by Two- and Three- Person Basic Medical Rescue Teams in Adults under Simulated Conditions

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