Selected Controversies in Cardiopulmonary Resuscitation

White, Simon; Himes, Daniel; Rouhani, Mazyar; Slovis, Corey M.

doi:10.1055/s-2001-13839

Cited by 6 publications

(8 citation statements)

References 105 publications

(185 reference statements)

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“…Van Walraven et al 11 found no significant difference in the percentage of patients surviving to one hour among those given lidocaine and those not given lidocaine. We agree with the conclusion of the International Guidelines Conference participants and those of White et al, 4 who recently reviewed data on cardiac arrest drugs, that the efficacy of lidocaine for VF or pulseless VT remains unproven.…”

Section: Amiodarone Versus Lidocainesupporting

confidence: 86%

“…[5][6][7] Since the 1970s, epinephrine has been the vasopressor of choice for treating cardiac arrest. 4 In 1984, Michael et al 8 noted "in animals…epineph-rine reverses and prevents arterial collapse and increases cerebral and myocardial perfusion pressures by vasoconstricting peripheral vascular beds. As a consequence…epi-nephrine increases cerebral and myocardial blood flow…during Epinephrine has both alphaadrenergic and beta-adrenergic stimulating properties.…”

Section: Epinephrine Versus Vasopressinmentioning

confidence: 97%

“…An ideal "pressor" should reestablish an adequate spontaneous circulation and blood pressure, optimize cardiac function, and preferentially shunt blood toward vital organs. 4 It should not increase myocardial oxygen demand or promote arrhythmias. The use of epinephrine, or adrenaline, as a resuscitation drug has been studied since the late 1800s.…”

Section: Epinephrine Versus Vasopressinmentioning

confidence: 99%

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P Rehospital M Anagement of C Ardiac a Rrest : H Ow U Seful a Re v Asopressor and a Ntiarrhythmic D Rugs ?

Wayne

Racht

Aghababian

et al. 2002

Prehospital Emergency Care

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Out-of-hospital resuscitation protocols for patients suffering cardiac arrest have historically included cardiopulmonary resuscitation, defibrillation, and rapid transport to a hospital. For many years, use of drugs to improve myocardial perfusion or to correct arrhythmias that occur during cardiac arrest has been part of prehospital efforts to revive patients in ventricular tachycardia or ventricular fibrillation. Use of some of these drugs, however, may be based more on tradition than on well-documented evidence of efficacy. The authors reviewed pertinent data on the vasopressors epinephrine and vasopressin and the antiarrhythmics amiodarone and lidocaine to evaluate the usefulness of these drugs in cardiac arrest. They found little clinical data supporting the prehospital use of lidocaine in cardiac arrest, and despite a great deal of laboratory and clinical data addressing the efficacy of epinephrine, there is no large, randomized, controlled clinical trial supporting its use. Data on amiodarone and vasopressin support the use of these drugs in out-of-hospital resuscitation efforts.

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Section: Amiodarone Versus Lidocainesupporting

confidence: 86%

Section: Epinephrine Versus Vasopressinmentioning

confidence: 97%

Section: Epinephrine Versus Vasopressinmentioning

confidence: 99%

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P Rehospital M Anagement of C Ardiac a Rrest : H Ow U Seful a Re v Asopressor and a Ntiarrhythmic D Rugs ?

Wayne

Racht

Aghababian

et al. 2002

Prehospital Emergency Care

Self Cite

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“…The adverse effects associated with the use of sodium bicarbonate include metabolic alkalosis and the generation of CO 2 , which could induce respiratory acidosis; furthermore, CO 2 , by rapidly crossing the blood brain barrier may result in cerebrospinal fluid acidosis and cerebral edema (5). To our knowledge, this is the first study evaluating the effects of sodium bicarbonate with transient hyperventilation to overcome increased CO 2 production.…”

Section: Discussionmentioning

confidence: 93%

“…Some studies have shown favorable results in terms of increased return of spontaneous circulation (ROSC) and hospital admission rates (2)(3)(4), while the majority of studies have found that sodium bicarbonate administration may be counter-productive because it increases tissue and central venous blood carbon dioxide (CO 2 ) tension, leading to paradoxical increase in respiratory acidosis (5)(6)(7)(8)(9)(10). As a result, the 2010 advanced cardiac life support (ACLS) guidelines for adults did not recommend the routine use of sodium bicarbonate during CPR, except for preexisting metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose (11).…”

Section: Introductionmentioning

confidence: 99%

Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study

Kim

Sohn

et al. 2018

J. Thorac. Dis.

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Background: Sodium bicarbonate administration during cardiopulmonary resuscitation (CPR) is controversial. Current guidelines recommend sodium bicarbonate injection in patients with existing metabolic acidosis, but clinical trials, particularly, those involving patients with acidosis, are limited. We aimed to evaluate the efficacy of sodium bicarbonate administration in out-of-hospital cardiac arrest (OHCA) patients with severe metabolic acidosis during prolonged CPR. Methods: Prospective, double-blind, randomized placebo-controlled pilot trial was conducted between January 2015 and December 2015, at a single center emergency department (ED). After 10 minutes of CPR, patients who failed to achieve return of spontaneous circulation (ROSC) and with severe metabolic acidosis (pH<7.1 or bicarbonate <10 mEq/L) were enrolled. Sodium bicarbonate (n=25) or normal saline (n=25) were administered. The primary end point was sustained ROSC. The secondary end points were the change of acidosis and good neurologic survival. Results: Sodium bicarbonate group had significant effect on pH (6.99 vs. 6.90, P=0.038) and bicarbonate levels (21.0 vs. 8.0 mEq/L, P=0.007). However, no significant differences showed between sodium bicarbonate and placebo groups in sustained ROSC (4.0% vs. 16.0%, P=0.349) or good neurologic survival at 1 month (0.0% vs. 4.0%, P=1.000). Conclusions: The use of sodium bicarbonate improved acid-base status, but did not improve the rate of ROSC and good neurologic survival. We could not draw a conclusion, but our pilot data could be used to design a larger trial to verify the efficacy of sodium bicarbonate.Trial Registration: NCT02303548 (http://www.ClinicalTrials.gov).

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Resuscitation Outcomes Consortium–Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and methodology behind an out-of-hospital cardiac arrest antiarrhythmic drug trial

Kudenchuk

Brown

Daya

et al. 2014

American Heart Journal

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Background Despite their wide use, whether antiarrhythmic drugs improve survival after out-of-hospital cardiac arrest (OHCA) is not known. The Resuscitation Outcomes Consortium Amiodarone, Lidocaine, or Placebo Study (ROC-ALPS) is evaluating the effectiveness of these drugs for OHCA due to shock-refractory ventricular fibrillation or pulseless ventricular tachycardia (VF/VT). Methods ALPS will randomize 3000 adults across North America with non-traumatic OHCA, persistent or recurring VF/VT after ≥1 shock and established vascular access to receive up to 450 mg amiodarone, 180 mg lidocaine, or placebo in the field using a double-blind protocol, along with standard resuscitation measures. The designated target population is all eligible randomized recipients of any dose of ALPS drug whose initial OHCA rhythm was VF/VT. A safety analysis includes all randomized patients regardless of their eligibility, initial arrhythmia or actual receipt of ALPS drug. ALPS’ primary outcome is survival to hospital discharge; a secondary outcome is functional survival at discharge assessed as a Modified Rankin Score ≤3. Results ALPS’ principal aim is to determine if survival is improved by amiodarone compared to placebo; secondary aims are to determine if survival is improved by lidocaine versus placebo, and/or by amiodarone versus lidocaine. Prioritizing comparisons in this manner acknowledges where differences in outcome are most expected based on existing knowledge. Each aim also represents a clinically relevant comparison between treatments that is worth investigating. Conclusions Results from ALPS will provide important information about the choice and value of antiarrhythmic therapies for VF/VT arrest with direct implications for resuscitation guidelines and clinical practice.

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Selected Controversies in Cardiopulmonary Resuscitation

Cited by 6 publications

References 105 publications

P Rehospital M Anagement of C Ardiac a Rrest : H Ow U Seful a Re v Asopressor and a Ntiarrhythmic D Rugs ?

P Rehospital M Anagement of C Ardiac a Rrest : H Ow U Seful a Re v Asopressor and a Ntiarrhythmic D Rugs ?

Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study

Resuscitation Outcomes Consortium–Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and methodology behind an out-of-hospital cardiac arrest antiarrhythmic drug trial

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