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Amiodarone and cardiac arrest: Systematic review and meta-analysis

      Highlights

      • Amiodarone significantly improves survival to hospital admission.
      • Amiodarone does not improve survival to hospital discharge.
      • Amiodarone does not improve neurological outcome.

      Abstract

      Introduction

      The 2015 Guidelines for Resuscitation recommend amiodarone as the antiarrhythmic drug of choice in the treatment of resistant ventricular fibrillation or pulseless ventricular tachycardia. We reviewed the effects of amiodarone on survival and neurological outcome after cardiac arrest.

      Methods

      We systematically searched MEDLINE and Cochrane Library from 1940 to March 2016 without language restrictions. Randomized control trials (RCTs) and observational studies were selected.

      Results

      Our search initially identified 1663 studies, 1458 from MEDLINE and 205 from Cochrane Library. Of them, 4 randomized controlled studies and 6 observational studies met the inclusion criteria and were selected for further review. Three randomized studies were included in the meta-analysis. Amiodarone significantly improves survival to hospital admission (OR = 1.402, 95% CI: 1.068–1.840, Z = 2.43, P = 0.015), but neither survival to hospital discharge (RR = 0.850, 95% CI: 0.631–1.144, Z = 1.07, P = 0.284) nor neurological outcome compared to placebo or nifekalant (OR = 1.114, 95% CI: 0.923–1.345, Z = 1.12, P = 0.475).

      Conclusions

      Amiodarone significantly improves survival to hospital admission. However there is no benefit of amiodarone in survival to discharge or neurological outcomes compared to placebo or other antiarrhythmics.

      Keywords

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