Pollak P Timothy, Wee Vinnie, Al-Hazmi Ahmed, Martin Janet, Zarnke Kelly B
Department of Medicine, Dalhousie University, Halifax, Nova Scotia.
Can J Cardiol. 2006 Mar 1;22(3):199-202. doi: 10.1016/s0828-282x(06)70896-0.
Although amiodarone significantly increases survival to hospital admission when used in resuscitation of out-of-hospital pulseless ventricular tachycardia and fibrillation, there are limited data on its utility for in-hospital arrests.
To determine whether the use of amiodarone, as recommended by the year 2000 American Heart Association Advanced Cardiac Life Support guidelines, improved survival following its introduction to the resuscitation algorithm at two tertiary care institutions.
Charts of 374 cardiac resuscitations were retrospectively studied at the two institutions. Basic survival outcomes and demographic data were recorded for cardiac arrests with ventricular tachyarrhythmias qualifying for administration of antiarrhythmic agents.
Qualifying rhythms were present in 95 patients. Clinical uptake of amiodarone was limited. In the 36 patients who received amiodarone, survival of resuscitation was 67% versus 83% (P=0.07) in the 59 patients receiving only other antiarrhythmic agents (chiefly lidocaine [94%]), while survival to discharge was 36.1% and 55.9% (P=0.06) in these two groups, respectively.
Following two years' experience with the introduction of intravenous amiodarone for resuscitation in the institutions, use was less than 50% and no clinically observable survival benefit could be documented. Possible explanations for the difference between this experience and that found in out-of-hospital resuscitation trials include differing patient populations and operator bias during resuscitation. These results should provoke other institutions to question whether amiodarone has improved survival of cardiac arrest under the conditions prevailing in their hospitals. A patient registry or prospective, randomized trial will be required to assess what parameters affect the success of intravenous amiodarone for resuscitation in-hospital.
尽管胺碘酮用于院外无脉性室性心动过速和心室颤动复苏时能显著提高入院生存率，但关于其在院内心脏骤停中的应用数据有限。
根据2000年美国心脏协会高级心血管生命支持指南的推荐，确定在两家三级医疗机构将胺碘酮引入复苏方案后是否能提高生存率。
对两家机构的374例心脏复苏病历进行回顾性研究。记录符合使用抗心律失常药物的室性快速心律失常心脏骤停患者的基本生存结果和人口统计学数据。
95例患者出现符合条件的心律。胺碘酮的临床应用有限。在36例接受胺碘酮治疗的患者中，复苏成功率为67%，而在仅接受其他抗心律失常药物（主要是利多卡因[94%]）治疗的59例患者中，复苏成功率为83%（P=0.07），两组患者的出院生存率分别为36.1%和55.9%（P=0.06）。
在两家机构引入静脉胺碘酮进行复苏两年后，其使用率低于50%，且未发现临床可观察到的生存获益。这种经验与院外复苏试验结果存在差异的可能原因包括不同的患者群体和复苏过程中的操作者偏倚。这些结果应促使其他机构质疑在其医院的现有条件下，胺碘酮是否能提高心脏骤停患者的生存率。需要通过患者登记或前瞻性随机试验来评估哪些参数会影响静脉胺碘酮院内复苏的成功率。
