Drugs in cardiac arrest – guess what works?

Just like epinephrine (adrenaline), amiodarone does not increase survival to hospital discharge in cardiac arrest patients. I doubt his will deter the people in the resuscitation room with their stopwatches from handing me these drugs and telling me I ought to be giving them though.

Amiodarone - a load of balls

 

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.

The use of antiarrhythmic drugs for adult cardiac arrest: A systematic review
Resuscitation. 2011 Jun;82(6):665-70

3 thoughts on “Drugs in cardiac arrest – guess what works?”

  1. Are you sure your conclusion that amiodarone doesn’t increase survival, period, is warranted? Per the review, it doesn’t increase survival *compared to lidocaine.” It could be that lidocaine is equally efficacious, but that doesn’t mean that neither drug works. We just don’t know yet.

  2. Cardiac arrest is typically a complicated condition, and all these studies prove and show is that anti arrythmics dont lead to increased rate of discharge of patients, but do lead to an increased amount of patients making it farther down the line. Maybe someone here can tell me why more studies havnt been done to show at the next step where we see the increase in mortality again and whats causing them next. If were able to get a greater number of patients with rosc shouldnt we look at where in the chain we are next failing patients and why? “every strike brings me closer to the next home run” babe ruth

Comments are closed.