Amiodarone for sustained stable ventricular tachycardia in the prehospital setting

Foerster, Christopher R.; Andrew, Emily; Smith, Karen; Bernard, Stephen

doi:10.1111/1742-6723.13146

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…In one large randomized double-blind study, 8 both of these agents have been associated with improved survival to hospital admission, 6 and amiodarone has been shown to be moderately effective for the treatment of sustained ventricular tachycardia. 5 Amiodarone is also associated with improved neurological outcome at hospital discharge for out-of-hospital cardiac arrest in patients who had ventricular fibrillation as the presenting dysrhythmia. 9 The prehospital literature is largely devoid of data describing safe and efficient practices for medication infusion delivery.…”

Section: Discussionmentioning

confidence: 99%

“…For example, in patients with refractory ventricular fibrillation, early administration of amiodarone has been associated with improved neurological outcomes for some out-of-hospital cardiac arrest (OHCA) patients. 5,6 The objective of this study was to assess the effectiveness, accuracy, and ease of use of a metronome-guided IV medication infusion technique. We hypothesized that when compared to conventional prehospital IV medication infusion techniques, the metronome technique would be associated with fewer errors and decreased time to target infusion rate.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study

Galvagno

Cloepin

Hannas

et al. 2021

Preprint

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BackgroundLimited research regarding administration of timed medication infusions in the prehospital environment has identified wide variability with accuracy, timing, and overall feasibility. This study was a pragmatic, randomized, controlled, crossover study comparing two different techniques for medication infusion administration. We hypothesized that the use of a metronome-based technique would decrease medication dosage errors and reduce time to administration for intravenous medication infusions. Methods Forty-two nationally registered paramedics were randomized to either a metronome-based technique versus a standard stopwatch-based technique. Each subject served as a control. Subjects were asked to establish an infusion of amiodarone at a dose of 150 mg administered over 10 minutes, simulating treatment of a hemodynamically stable patient with sustained monomorphic ventricular tachycardia. Descriptive statistics and multiple linear regression were used for data analysis. Results When compared to a standard stopwatch-based technique, a metronome-based technique was associated with faster time to goal, fewer mid-infusion adjustments, and greater ease of use. Conclusions Use of a metronome technique for establishing medication infusion rates may help prehospital clinicians provide safer and more precise medication delivery.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study

Galvagno

Cloepin

Hannas

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Infusions of lidocaine and amiodarone may be associated with clinically relevant outcomes, and proper dosing is essential. In one large randomized double-blind study [ 9 ], both of these agents have been associated with improved survival to hospital admission [ 5 ], and amiodarone has been shown to be moderately effective for the treatment of sustained ventricular tachycardia [ 4 ]. Amiodarone is also associated with improved neurological outcome at hospital discharge for out-of-hospital cardiac arrest in patients who had ventricular fibrillation as the presenting dysrhythmia [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…As the scope of prehospital medicine continues to evolve, the ability to quickly and safely administer IV medication infusions will remain an essential skill to enhance patient outcomes. For example, in patients with stable ventricular tachycardia, early administration of amiodarone has been associated with improved outcomes and following a bolus out-of-hospital cardiac arrest (OHCA) patients, an infusion is recommended [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of a metronome-guided prehospital medication infusion technique with standard calculation: a simulated randomized, controlled, cross-over study

et al. 2021

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Background Limited research regarding administration of timed medication infusions in the prehospital environment has identified wide variability with accuracy, timing, and overall feasibility. This study was a quality improvement project that utilized a randomized, controlled, crossover study design to compare two different educational techniques for medication infusion administration. We hypothesized that the use of a metronome-based technique would decrease medication dosage errors and reduce time to administration for intravenous medication infusions. Methods Forty-two nationally registered paramedics were randomized to either a metronome-based technique versus a standard stopwatch-based technique. Each subject served as a control. Subjects were asked to establish an infusion of amiodarone at a dose of 150 mg administered over 10 min, simulating treatment of a hemodynamically stable patient with sustained monomorphic ventricular tachycardia. Descriptive statistics and a repeated measures mixed linear regression model were used for data analysis. Results When compared to a standard stopwatch-based technique, a metronome-based technique was associated with faster time to goal (median 34 s [IQR, 22–54] vs 50 s; [IQR 38–61 s], P = 0.006) and fewer mid-infusion adjustments. Ease of use was reported to be significantly higher for the metronome group (median ranking 5, IQR 4–5) compared to the standard group (median ranking 2, IQR 2–3; P < 0.001). Conclusions Knowledge regarding a metronome technique may help EMS clinicians provide safe and effective IV infusions. Such a technique may be beneficial for learners and educators alike.

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“…Amiodarone for regular, stable, wide-complex (not necessarily ventricular) tachycardia in the prehospital setting I read with interest the article by Foerster et al 1 This retrospective study concluded that amiodarone was safe and moderately effective (more so than previous reports) for termination of stable ventricular tachycardia (VT) in the prehospital setting. The authors appropriately discuss the relevant limitations of the trial's retrospective design and report the lack of formal ECG interpretation.…”

mentioning

confidence: 99%

Re: Amiodarone for sustained stable ventricular tachycardia in the prehospital setting

deSouza

2018

Emerg Medicine Australasia

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Amiodarone for sustained stable ventricular tachycardia in the prehospital setting

Cited by 4 publications

References 8 publications

Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study

Comparison of a Metronome-guided Prehospital Medication Infusion Technique with Manual Calculation: A Simulated Randomized, Controlled, Cross-over Study

Comparison of a metronome-guided prehospital medication infusion technique with standard calculation: a simulated randomized, controlled, cross-over study

Re: Amiodarone for sustained stable ventricular tachycardia in the prehospital setting

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