Amiodarone for Resuscitation After Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation - ARREST

Jul 09, 2003
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Date Presented:
01/01/1999
Date Published:
01/01/1999
Date Updated:
07/09/2003
Original Posted Date:
07/09/2003
References

Description:

Amiodarone versus placebo in patients with out-of-hospital cardiac arrest after three or more precordial shocks.

Hypothesis:

The administration of intravenous amiodarone would be associated with improved resuscitation during cardiac arrest as measured by survival to admission to the hospital.

Study Design

Study Design:

Patients Screened: 3954
Patients Enrolled: 507
Female: 23%

Patient Populations:

Eligible patients were those suffering non-traumatic cardiac arrest who developed ventricular fibrillation or pulseless ventricular tachycardia during resuscitation and failed three or more precordial shocks.

Exclusions:

patients were excluded if precordial shocks terminated the unsatble venrticular arrhythmia.

Primary Endpoints:

Admission to the hospital with a stable, organizing rhythm abd blood pressure.

Secondary Endpoints:

Adverse effects of the medication, the number of precordial shocks required after administration of amiodarone or placebo, total duration of resuscitative measures and need for additional antiarrhythmic drugs.

Drug/Procedures Used:

Patients were administered 300 mg of amiodarone or placebo as an intravenous bolus.

Principal Findings:

Of 504 patients, 39% survived to hospital admission. Patients who received amiodarone were more likely to be resuscitated and admitted to the hospital (44% versus 34%; p=0.03). There were slight reductions in the duration of resuscitative efforts, number of shocks delivered, and the number of patients needing additional antiarrhythmic agents, but these findings did not reach statistical significance.

Interpretation:

Amiodarone improved survival to admission to the hospital as compared to placebo in patients with shock-refractory cardiac arrest. The survival rate to admission (39%) is higher than is usually found and may reflect the excellent emergency medical services available in the study location. This study was not powered to detect a mortality difference between placebo and amiodarone, but suggests a beneficial effect of amiodarone as an initial antiarrhythmic agent. Nevertheless, further studies are warranted to definitively address the value of intravenous amiodarone as an antiarrhythmic agent during cardiac arrest.

References:

1. Kudenchuk PJ, Cobb LA, Copass MK, Cummins RO, Doherty AM, Fahrenbruch CE, Hallstrom AP, Murray WA, Olsufka M, Walsh T. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med 1999 Sep 16;341(12):871-8.

Keywords: Tachycardia, Ventricular, Resuscitation, Out-of-Hospital Cardiac Arrest, Emergency Medical Services, Survival Rate, Ventricular Fibrillation, Coronary Disease, Heart Arrest


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