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Review| Volume 221, P780-788, October 15, 2016

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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      References

        • Berdowski J.
        • Berg R.A.
        • Tijssen J.G.
        • Koster R.W.
        Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies.
        Resuscitation. 2010; 81: 1479-1487
        • Grasner J.T.
        • Herlitz J.
        • Koster R.W.
        • Rosell-Ortiz F.
        • Stamatakis L.
        • Bossaert L.
        Quality management in resuscitation—towards a European cardiac arrest registry (EuReCa).
        Resuscitation. 2011; 82: 989-994
        • Grasner J.T.
        • Bossaert L.
        Epidemiology and management of cardiac arrest: what registries are revealing.
        Best Pract. Res. Clin. Anaesthesiol. 2013; 27: 293-306
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • American Heart Association Statistics Committee and Stroke Statistics Subcommittee
        • et al.
        Heart disease and stroke statistics—2014 update: a report from the American Heart Association.
        Circulation. 2014; 129: e28-e292
        • Perkins G.D.
        • Lockey A.S.
        • de Belder M.A.
        • Moore F.
        • Weissberg P.
        • Gray H.
        National initiatives to improve outcomes from out-of-hospital cardiac arrest in England.
        Emerg Med J. 2016 Jul; 33: 448-451
        • Kleinman M.E.
        • Brennan E.E.
        • Goldberger Z.D.
        • et al.
        Part 5: adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S414-S435
        • Sasson C.
        • Rogers M.A.
        • Dahl J.
        • Kellermann A.L.
        Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.
        Circ. Cardiovasc. Qual. Outcomes. 2010; 3: 63-81
        • Wissenberg M.
        • Lippert F.K.
        • Folke F.
        • et al.
        Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest.
        JAMA. 2013; 310: 1377-1384
        • Holmberg M.
        • Holmberg S.
        • Herlitz J.
        Factors modifying the effect of bystander cardiopulmonary resuscitation on survival in out-of-hospital cardiac arrest patients in Sweden.
        Eur. Heart J. 2001; 22: 511-519
        • Waalewijn R.A.
        • Tijssen J.G.
        • Koster R.W.
        Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST).
        Resuscitation. 2001; 50: 273-279
        • Iwami T.
        • Nichol G.
        • Hiraide A.
        • et al.
        Continuous improvements in “chain of survival” increased survival after out-of-hospital cardiac arrests: a large-scale population-based study.
        Circulation. 2009; 119: 728-734
        • Soar J.
        • Nolan J.P.
        • Böttiger B.W.
        • et al.
        European Resuscitation Council guidelines for resuscitation 2015: section 3. Adult advanced life support.
        Resuscitation. 2015; 95: 100-147
        • Link M.S.
        • Berkow L.C.
        • Kudenchuk P.J.
        • et al.
        Part 7: adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S444-S464
        • Pollak P.T.
        Oral amiodarone: historical overview and development.
        Pharmacotherapy. 1998; 18: 121S-126S
        • Dorian P.
        • Cass D.
        • Schwartz B.
        • Cooper R.
        • Gelaznikas R.
        • Barr A.
        Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation.
        N. Engl. J. Med. 2002; 346: 884-890
        • Kudenchuk P.J.
        • Cobb L.A.
        • Copass M.K.
        • et al.
        Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation.
        N. Engl. J. Med. 1999; 341: 871-878
        • Huang Y.
        • He Q.
        • Yang M.
        • Zhan L.
        Antiarrhythmia drugs for cardiac arrest: a systemic review and meta-analysis.
        Crit. Care. 2013; 17: R173
        • Boyd T.
        • Brady W.
        The “Code Drugs in Cardiac Arrest”—the use of cardioactive medications in cardiac arrest resuscitation.
        Am. J. Emerg. Med. 2012; 30: 811-818
        • Ong M.E.
        • Pellis T.
        • Link M.S.
        The use of antiarrhythmic drugs for adult cardiac arrest: a systematic review.
        Resuscitation. 2011; 82: 665-670
        • Horn J.
        • Cronberg T.
        • Taccone F.S.
        Prognostication after cardiac arrest.
        Curr. Opin. Crit. Care. 2014; 20: 280-286
        • Higgins J.P.
        • Altman D.G.
        • Gøtzsche P.C.
        • Cochrane Bias Methods Group
        • Cochrane Statistical Methods Group
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Kudenchuk P.J.
        • Brown S.P.
        • Daya M.
        • Investigators R.O.C.
        • et al.
        Amiodarone, lidocaine, or placebo in out-of-hospital cardiac arrest.
        N. Engl. J. Med. 2016; 374: 1711-1722
        • Amino M.
        • Yoshioka K.
        • Opthof T.
        • et al.
        Comparative study of nifekalant versus amiodarone for shock-resistant ventricular fibrillation in out-of-hospital cardiopulmonary arrest patients.
        J. Cardiovasc. Pharmacol. 2010; 55: 391-398
        • Skrifvars M.B.
        • Kuisma M.
        • Boyd J.
        • et al.
        The use of undiluted amiodarone in the management of out-of-hospital cardiac arrest.
        Acta Anaesthesiol. Scand. 2004; 48: 582-587
        • Amino M.
        • Inokuchi S.
        • Nagao K.
        • SOS-KANTO 2012 Study Group
        • et al.
        Nifekalant hydrochloride and amiodarone hydrochloride result in similar improvements for 24-hour survival in cardiopulmonary arrest patients: the SOS-KANTO 2012 study.
        J. Cardiovasc. Pharmacol. 2015; 66: 600-609
        • Rea R.S.
        • Kane-Gill S.L.
        • Rudis M.I.
        • et al.
        Comparing intravenous amiodarone or lidocaine, or both, outcomes for inpatients with pulseless ventricular arrhythmias.
        Crit. Care Med. 2006; 34: 1617-1623
        • Valdes S.O.
        • Donoghue A.J.
        • Hoyme D.B.
        • American Heart Association Get With The Guidelines-Resuscitation Investigators
        • et al.
        Outcomes associated with amiodarone and lidocaine in the treatment of in-hospital pediatric cardiac arrest with pulseless ventricular tachycardia or ventricular fibrillation.
        Resuscitation. 2014; 85: 381-386
        • Harayama N.
        • Nihei S.
        • Nagata K.
        • et al.
        Comparison of nifekalant and amiodarone for resuscitation of out-of-hospital cardiopulmonary arrest resulting from shock-resistant ventricular fibrillation.
        J. Anesth. 2014; 28: 587-592
        • Pollak P.T.
        • Wee V.
        • Al-Hazmi A.
        • Martin J.
        • Zarnke K.B.
        The use of amiodarone for in-hospital cardiac arrest at two tertiary care centres.
        Can. J. Cardiol. 2006; 22: 199-202
        • Guyatt G.H.
        • Oxman A.D.
        • Kunz R.
        • GRADE Working Group
        • et al.
        GRADE guidelines: 7. Rating the quality of evidence—inconsistency.
        J. Clin. Epidemiol. 2011; 64: 1294-1302
        • Pantazopoulos I.N.
        • Troupis G.T.
        • Pantazopoulos C.N.
        • Xanthos T.T.
        Nifekalant in the treatment of life-threatening ventricular tachyarrhythmias.
        World J. Cardiol. 2011; 3: 169-176