The use of undiluted amiodarone in the management of out‐of‐hospital cardiac arrest

Abstract

The present study suggests that amiodarone can be administered undiluted without unmanageable haemodynamical side-effects in the treatment of out-of-hospital cardiac arrest. This is likely to save time and simplifies the treatment protocol in the prehospital setting.

Part 8: Adult Advanced Cardiovascular Life Support

“…In blinded randomized controlled clinical trials in adults with refractory VF/pulseless VT in the out-of-hospital setting, 134,136 paramedic administration of amiodarone (300 mg 134 or 5 mg/kg 136 ) improved hospital admission rates when compared with administration of placebo 134 or 1.5 mg/kg of lidocaine. 136 Additional studies [283][284][285][286][287] documented consistent improvement in termination of arrhythmias when amiodarone was given to humans or animals with VF or hemodynamically unstable VT. A higher incidence of bradycardia and hypotension was reported for amiodarone in one out-of-hospital study. 134 A canine study 288 noted that administration of a vasoconstrictor before amiodarone prevented hypotension.…”

Guideline for resuscitation in cardiac arrest after cardiac surgery

“…Other studies have also shown a consistent improvement in defibrillation response when amiodarone was given to humans or animals with VF or haemodynamically unstable VT [85][86][87][88][89]. Somberg et al showed in a double-blinded study that amiodarone is more effective than lidocaine in the treatment of shock-resistant VT (immediate VT termination in 78% vs 27%, respectively, p < 0.05) and that hypotension was less frequent than with lidocaine [88].…”

Comparing intravenous amiodarone or lidocaine, or both, outcomes for inpatients with pulseless ventricular arrhythmias*

“…Use of lower amiodarone doses in our study may have been caused by time needed to obtain the drug, open the vials, dilute, and draw up the medication. Difficulties in preparation and administration of amiodarone have been reported during cardiac arrest (18). For practical reasons, 150 mg may be more commonly administered to the patient in an emergent situation because one ampule of amiodarone contains this amount (19).…”

“…A possible solution may be to administer undiluted amiodarone into a centrally located vein. The hemodynamic effects seem to be manageable, and side effects occur no more frequently under these conditions than in those who did not receive the drug, based on a retrospective study (18).…”