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Acute hospital administration of amiodarone and/or lidocaine in shockable patients presenting with out-of-hospital cardiac arrest: A nationwide cohort study.
Int J Cardiol 2017; 227:292-298IJ

Abstract

BACKGROUND

Terminating ventricular fibrillation (VF) or pulseless ventricular tachyarrhythmia (VT) is critical for successful resuscitation of patients with shockable cardiac arrest. In the event of shock-refractory VF, applicable guidelines suggest use of anti-arrhythmic agents. However, subsequent long-term outcomes remain unclear. A nationwide cohort study was therefore launched, examining 1-year survival rates in patients given amiodarone and/or lidocaine for cardiac arrest.

METHODS

Medical records accruing between years 2004 and 2011 were retrieved from the Taiwan National Health Insurance Research Database (NHIRD) for review. This repository houses all insurance claims data for nearly the entire populace (>99%). Candidates for study included all non-traumatized adults receiving DC shock and cardiopulmonary resuscitation immediately or within 6h of emergency room arrival. Analysis was based on data from emergency rooms and hospitalization.

RESULTS

One-year survival rates by treatment group were 8.27% (534/6459) for amiodarone, 7.15% (77/1077) for lidocaine, 11.10% (165/1487) for combined amiodarone/lidocaine use, and 3.26% (602/18,440) for use of neither amiodarone nor lidocaine (all, p<0.0001). Relative to those given neither medication, odds ratios for 1-year survival via multiple regression analysis were 1.84 (95% CI: 1.58-2.13; p<0.0001) for amiodarone, 1.88 (95% CI: 1.40-2.53; p<0.0001) for lidocaine, and 2.18 (95% CI: 1.71-2.77; p<0.0001) for dual agent use.

CONCLUSIONS

In patients with shockable cardiac arrest, 1-year survival rates were improved with association of using amiodarone and/or lidocaine, as opposed to non-treatment. However, outcomes of patients given one or both medications did not differ significantly in intergroup comparisons.

Authors+Show Affiliations

Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan.Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.Department of Internal Medicine (Cardiology), College of Medicine, National Taiwan University, Taipei, Taiwan.Division of Cardiology, Department of Internal Medicine, Cardinal Tien Hospital Yonghe Branch, New Taipei City, Taiwan.Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan. Electronic address: wjchen1955@ntu.edu.tw.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27843049

Citation

Huang, Chien-Hua, et al. "Acute Hospital Administration of Amiodarone And/or Lidocaine in Shockable Patients Presenting With Out-of-hospital Cardiac Arrest: a Nationwide Cohort Study." International Journal of Cardiology, vol. 227, 2017, pp. 292-298.
Huang CH, Yu PH, Tsai MS, et al. Acute hospital administration of amiodarone and/or lidocaine in shockable patients presenting with out-of-hospital cardiac arrest: A nationwide cohort study. Int J Cardiol. 2017;227:292-298.
Huang, C. H., Yu, P. H., Tsai, M. S., Chuang, P. Y., Wang, T. D., Chiang, C. Y., ... Chen, W. J. (2017). Acute hospital administration of amiodarone and/or lidocaine in shockable patients presenting with out-of-hospital cardiac arrest: A nationwide cohort study. International Journal of Cardiology, 227, pp. 292-298. doi:10.1016/j.ijcard.2016.11.101.
Huang CH, et al. Acute Hospital Administration of Amiodarone And/or Lidocaine in Shockable Patients Presenting With Out-of-hospital Cardiac Arrest: a Nationwide Cohort Study. Int J Cardiol. 2017 Jan 15;227:292-298. PubMed PMID: 27843049.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute hospital administration of amiodarone and/or lidocaine in shockable patients presenting with out-of-hospital cardiac arrest: A nationwide cohort study. AU - Huang,Chien-Hua, AU - Yu,Ping-Hsun, AU - Tsai,Min-Shan, AU - Chuang,Po-Ya, AU - Wang,Tzung-Dau, AU - Chiang,Chih-Yen, AU - Chang,Wei-Tien, AU - Ma,Matthew Huei-Ming, AU - Tang,Chao-Hsiun, AU - Chen,Wen-Jone, Y1 - 2016/11/09/ PY - 2016/08/08/received PY - 2016/10/10/revised PY - 2016/11/06/accepted PY - 2016/11/16/pubmed PY - 2017/11/7/medline PY - 2016/11/16/entrez KW - 1-Year survival KW - Amiodarone KW - Lidocaine KW - Out-of-hospital cardiac arrest KW - Shockable rhythm SP - 292 EP - 298 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 227 N2 - BACKGROUND: Terminating ventricular fibrillation (VF) or pulseless ventricular tachyarrhythmia (VT) is critical for successful resuscitation of patients with shockable cardiac arrest. In the event of shock-refractory VF, applicable guidelines suggest use of anti-arrhythmic agents. However, subsequent long-term outcomes remain unclear. A nationwide cohort study was therefore launched, examining 1-year survival rates in patients given amiodarone and/or lidocaine for cardiac arrest. METHODS: Medical records accruing between years 2004 and 2011 were retrieved from the Taiwan National Health Insurance Research Database (NHIRD) for review. This repository houses all insurance claims data for nearly the entire populace (>99%). Candidates for study included all non-traumatized adults receiving DC shock and cardiopulmonary resuscitation immediately or within 6h of emergency room arrival. Analysis was based on data from emergency rooms and hospitalization. RESULTS: One-year survival rates by treatment group were 8.27% (534/6459) for amiodarone, 7.15% (77/1077) for lidocaine, 11.10% (165/1487) for combined amiodarone/lidocaine use, and 3.26% (602/18,440) for use of neither amiodarone nor lidocaine (all, p<0.0001). Relative to those given neither medication, odds ratios for 1-year survival via multiple regression analysis were 1.84 (95% CI: 1.58-2.13; p<0.0001) for amiodarone, 1.88 (95% CI: 1.40-2.53; p<0.0001) for lidocaine, and 2.18 (95% CI: 1.71-2.77; p<0.0001) for dual agent use. CONCLUSIONS: In patients with shockable cardiac arrest, 1-year survival rates were improved with association of using amiodarone and/or lidocaine, as opposed to non-treatment. However, outcomes of patients given one or both medications did not differ significantly in intergroup comparisons. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/27843049/Acute_hospital_administration_of_amiodarone_and/or_lidocaine_in_shockable_patients_presenting_with_out_of_hospital_cardiac_arrest:_A_nationwide_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(16)33559-8 DB - PRIME DP - Unbound Medicine ER -