Antiarrhythmia drugs for cardiac arrest: a systemic review and meta-analysis

Abstract

IntroductionAntiarrhythmia agents have been used in the treatment of cardiac arrest, and we aimed to review the relevant clinical controlled trials to assess the effects of antiarrhythmics during cardiopulmonary resuscitation.MethodsWe searched databases including Cochrane Central Register of Controlled Trials; MEDLINE, and EMBASE. Clinical controlled trials that addressed the effects of antiarrhythmics (including amiodarone, lidocaine, magnesium, and other new potassium-channel blockers) on the outcomes of cardiac arrest were included. Data were collected independently by two authors. The risk ratio of each outcome was collected, and meta-analysis was used for data synthesis if appropriate. Heterogeneity was assessed with the χ2 test and the I2 test.ResultsTen randomized controlled trials and seven observational trials were identified. Amiodarone (relative risk (RR), 0.82; 95% confidence interval (CI), 0.54 to 1.24), lidocaine (RR, 2.26; 95% CI, 0.93to 5.52), magnesium (RR, 0.82; 95% CI, 0.54 to 1.24) and nifekalant were not shown to improve the survival to hospital discharge compared with placebo, but amiodarone, lidocaine, and nifekalant were shown to be beneficial to initial resuscitation, assessed by the rate of return of spontaneous circulation and survival to hospital admission, with amiodarone being superior to lidocaine (RR, 1.28; 95% CI, 0.57 to 2.86) and nifekalant (RR, 0.50; 95% CI, 0.19 to 1.31). Bretylium and sotalol were not shown to be beneficial.ConclusionsOur review suggests that when administered during resuscitation, antiarrhythmia agents might not improve the survival to hospital discharge, but they might be beneficial to initial resuscitation. This is consistent with the AHA 2010 guidelines for resuscitation and cardiovascular emergency, but more studies with good methodologic quality and large numbers of patients are still needed to make further assessment.

Helicopter-based in-water resuscitation with chest compressions: a pilot study

“…Both, antiarrhythmic drugs35 and adrenaline36 during CPR do not result in a long-term survival benefit. The cannulisation with the EZ-IO power drill is fast and easy to perform37 and appears to be the only realistic approach to vascular access, since peripheral venous lines do not appear to be feasible in moving, hypothermic and peripherally vasoconstricted patients in the platform.…”

Improving Survival From Cardiac Arrest: A Review of Contemporary Practice and Challenges

“…33,44 Amiodarone is recommended over lidocaine, sotalol, and nifekalant because of its greater effectiveness for terminating ventricular arrhythmias, but this has translated only to an improvement in survival to hospital admission and not to hospital discharge. 33,53 A recent, large, multicenter trial of amiodarone, lidocaine, and placebo in shockable out-of-hospital cardiac arrest likewise showed no significant differences in survival to hospital discharge (hospital survival 24.4% with amiodarone, 23.7% with lidocaine, and 21.0% with placebo; P¼.08). 44 Unlike patients with unwitnessed out-of-hospital cardiac arrest, those with witnessed out-of-hospital cardiac arrest had modestly lower mortality if they received either antiarrhythmic drug rather than placebo (27.7% and 27.8% versus 22.7%; P<.05), demonstrating that circumstances of arrest can influence efficacy of treatment.…”

“…24 For patients with ventricular arrhythmias refractory to at least 1 defibrillator shock, administration of an antiarrhythmic drug may improve efficacy of subsequent shocks and increase the likelihood of return of spontaneous circulation. 33 The evidence showing that antiarrhythmic agents reduce mortality from cardiac arrest is limited, and none of the antiarrhythmic agents studied during cardiac arrest resulted in increased rates of survival to hospital discharge. 33,44 Amiodarone is recommended over lidocaine, sotalol, and nifekalant because of its greater effectiveness for terminating ventricular arrhythmias, but this has translated only to an improvement in survival to hospital admission and not to hospital discharge.…”

“…33 The evidence showing that antiarrhythmic agents reduce mortality from cardiac arrest is limited, and none of the antiarrhythmic agents studied during cardiac arrest resulted in increased rates of survival to hospital discharge. 33,44 Amiodarone is recommended over lidocaine, sotalol, and nifekalant because of its greater effectiveness for terminating ventricular arrhythmias, but this has translated only to an improvement in survival to hospital admission and not to hospital discharge. 33,53 A recent, large, multicenter trial of amiodarone, lidocaine, and placebo in shockable out-of-hospital cardiac arrest likewise showed no significant differences in survival to hospital discharge (hospital survival 24.4% with amiodarone, 23.7% with lidocaine, and 21.0% with placebo; P¼.08).…”

Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis

“…Study design RCT (primary analysis); prospective and retrospective studies (secondary analysis) patients with bystander-witnessed CA. Before this RCT, a recent meta-analysis analyzed the efficacy of anti-arrhythmic drugs in the treatment of CA, 13 but it included drugs not currently recommended and suffered from large biases in the studies included. For instance, many of these studies were retrospective chart reviews, with unbalanced baseline characteristics, 14 or different timing of drug administration and severely under-dosed treatments.…”