Abstract
Amiodarone is recommended for shock-refractory ventricular arrhythmia during resuscitation; however, it is unknown whether amiodarone is effective for preventing ventricular arrhythmia recurrence in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). We investigated the effectiveness of prophylactic amiodarone in preventing ventricular arrhythmia recurrence in OHCA survivors. Data of consecutive adult non-traumatic OHCA survivors treated with TTM between 2010 and 2016 were extracted from prospective cardiac arrest registries of four tertiary care hospitals. The prophylactic amiodarone group was matched in a 1:1 ratio by using propensity scores. The primary outcome was ventricular arrhythmia recurrence requiring defibrillation during TTM. Among 295 patients with an initially shockable rhythm and 149 patients with initially non-shockable-turned-shockable rhythm, 124 patients (27.9%) received prophylactic amiodarone infusion. The incidence of ventricular arrhythmia recurrence was 11.26% (50/444). Multivariate analysis showed prophylactic amiodarone therapy to be the independent factor associated with ventricular arrhythmia recurrence (odds ratio 1.95, 95% CI 1.04–3.65, p = 0.04), however, no such association was observed (odds ratio 1.32, 95% CI 0.57–3.04, p = 0.51) after propensity score matching. In this propensity-score-matched study, prophylactic amiodarone infusion had no effect on preventing ventricular arrhythmia recurrence in OHCA survivors with shockable cardiac arrest. Prophylactic amiodarone administration must be considered carefully.
Highlights
Despite recent advances in critical care, the mortality rate of out-of-hospital cardiac arrest (OHCA) remains high [1]
From a total of 901 non-traumatic OHCA survivors treated with temperature management (TTM), 295 patients with initially shockable OHCA and 149 patients with shockable rhythm during cardiopulmonary resuscitation (CPR) from initially non-shockable OHCA were included
Of the 444 patients, 124 patients (27.9%) who received prophylactic amiodarone infusion were categorized into the prophylactic group and the other 320 patients were included in the non-prophylactic amiodarone group, see Figure 1
Summary
Despite recent advances in critical care, the mortality rate of out-of-hospital cardiac arrest (OHCA) remains high [1]. The optimal target temperature and duration are unknown, targeted temperature management (TTM) at 32–36 ◦C for 24 h is known to reduce mortality and improve neurologic outcomes after cardiac arrest, especially, when the initial rhythm is ventricular fibrillation (VF) or ventricular tachycardia (VT) [2,3,4]. Post-cardiac arrest care should focus on optimizing cardiopulmonary function, minimizing reperfusion injury, controlling the body temperature, treating the underlying cause, and preventing re-arrest [5]. The issue of whether to initiate or continue anti-arrhythmic therapy after the return of spontaneous circulation (ROSC) from cardiac arrest to prevent recurrent ventricular arrhythmia (VF or pulseless VT) has not yet been addressed
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