Prehospital amiodarone may increase the incidence of acute respiratory distress syndrome among patients at risk

Abstract

Purpose Amiodarone has been implicated as a risk factor for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) when used in the hospital. This study aims to estimate whether prehospital amiodarone also increases the risk of ALI/ARDS. Materials Adult patients admitted to 22 centers with at least 1 risk factor for developing ALI were recruited. In a secondary analysis of this cohort, the prehospital use of amiodarone was documented on admission, and the patients followed for the primary outcome of ALI and secondary outcomes of ARDS, the need for invasive ventilation, and mortality. Dose/duration of amiodarone therapy was not available. Propensity matching was performed to account for imbalances in being assigned to amiodarone. The adjusted risk for ALI/ARDS was then estimated from a conditional logistic regression model of this propensity-matched set. Results Forty of 5584 patients were on amiodarone at the time of hospitalization; of those, 6 developed ALI, with 5 progressing to ARDS. In comparison, 371 patients not on amiodarone developed ALI, with 224 having ARDS. After propensity score matching, the prehospital use of amiodarone was not statistically associated with an increased risk for all ALI (odds ratio [OR], 1.8; 95% confidence interval [CI], 0.7–5.0; P = .25), invasive ventilation (OR, 1.9; 95% CI, 1.0–3.6; P = .059), or in-hospital mortality (OR, 1.2; 95% CI, 0.5–2.9; P = .75); but its use appeared to significantly increase the risk for ARDS (OR 3.8; 95% CI, 1.1–13.1; P = .036). Conclusions Prehospital use of amiodarone may independently increase the risk for ARDS in patients who have at least 1 predisposing condition for ALI.

Amiodarone in the COVID-19 Era: Treatment for Symptomatic Patients Only, or Drug to Prevent Infection?

“…It is important to keep in mind that amiodarone-induced pulmonary fibrosis is a rare event that typically occurs after months to years of continued drug administration. It has also been shown that prehospital use of amiodarone may independently increase the risk for ARDS in patients with predisposing conditions for acute lung injury (ALI) [ 26 ]. Contributing factors to amiodarone-induced pulmonary toxicity include its direct cytotoxic effects (principally mediated by N -DEA), phospholipidosis, immunological mechanisms, and activation of the angiotensin system; however, the precise mechanisms contributing to amiodarone-induced pulmonary toxicity remain incompletely understood.…”

Amiodarone in COVID-19: let’s not forget its potential for pulmonary toxicity

“…Amiodarone-associated ARDS has been reported in patients who have undergone surgery or pulmonary angiography though with limited literature. 2 Importantly, a prospective cohort study 3 reported that prehospital use of amiodarone increased nearly four times the odds of developing ARDS among patients at risk for acute lung injury (odds ratio = 3.8; 95% confidence interval 1.1–13.1). Indeed, the causative pathogen for COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is able to induce acute lung injury in COVID-19 through down-regulation of angiotensin-converting enzyme 2.…”