Rea Rhonda S, Kane-Gill Sandra L, Rudis Maria I, Seybert Amy L, Oyen Lance J, Ou Narith N, Stauss Julie L, Kirisci Levent, Idrees Umbreen, Henderson Sean O
University of Pittsburgh School of Pharmacy, Center for Pharmacoinformatics and Outcomes Research, Department of Pharmaceutical Sciences, PA, and Saint Mary's Hospital-Mayo Foundation, Rochester, MN, USA.
Crit Care Med. 2006 Jun;34(6):1617-23. doi: 10.1097/01.CCM.0000217965.30554.D8.
To compare survival rates of patients with in-hospital cardiac arrest due to pulseless ventricular tachycardia/ventricular fibrillation treated with lidocaine, amiodarone, or amiodarone plus lidocaine.
Multicenter retrospective medical record review.
Three academic medical centers in the United States.
Hospitalized adult patients who received amiodarone, lidocaine, or a combination for pulseless ventricular tachycardia/ventricular fibrillation between August 1, 2000, and July 31, 2002.
Data were collected according to the Utstein style. In-hospital proportion of patients living at 24 hrs and discharge were analyzed using chi-square analysis. Of the 605 patient medical records reviewed, 194 met criteria for inclusion (n=79 for lidocaine, n=74 for amiodarone, n=41 for combination). Available data showed no difference in proportion of patients alive 24 hrs post-cardiac arrest (p=.39). Cox regression analysis indicated a decreased likelihood of survival in patients with pulseless ventricular tachycardia/ventricular fibrillation as an initial rhythm as compared with those who presented with bradycardia followed by pulseless ventricular tachycardia/ventricular fibrillation and in those patients who received amiodarone as compared with lidocaine. However, only 14 patients (25%) in the amiodarone group received the recommended initial 300-mg intravenous bolus, and amiodarone was administered an average of 8 mins later in the code compared with lidocaine (p<.001).
These results generate the hypothesis that inpatients with cardiac arrest may have different benefits from lidocaine and amiodarone than previously demonstrated. Inadequate dosing and later administration of amiodarone in the code were two confounding factors in this study. Prospective studies evaluating these agents are warranted.
比较利多卡因、胺碘酮或胺碘酮加利多卡因治疗无脉性室性心动过速/心室颤动所致院内心脏骤停患者的生存率。
多中心回顾性病历审查。
美国的三个学术医疗中心。
2000年8月1日至2002年7月31日期间因无脉性室性心动过速/心室颤动接受胺碘酮、利多卡因或联合用药治疗的住院成年患者。
数据按照Utstein格式收集。采用卡方分析对24小时存活及出院患者的院内比例进行分析。在审查的605份患者病历中，194份符合纳入标准（利多卡因组79例，胺碘酮组74例，联合用药组41例）。现有数据显示心脏骤停后24小时存活患者比例无差异（p = 0.39）。Cox回归分析表明，与初始节律为心动过缓继以无脉性室性心动过速/心室颤动的患者以及与利多卡因治疗的患者相比，以无脉性室性心动过速/心室颤动为初始节律的患者生存可能性降低。然而，胺碘酮组仅14例患者（25%）接受了推荐的初始300毫克静脉推注，与利多卡因相比，胺碘酮在心肺复苏过程中的给药平均延迟8分钟（p < 0.001）。
这些结果提出了一个假设，即心脏骤停的住院患者从利多卡因和胺碘酮治疗中获得的益处可能与以往证明的不同。本研究中胺碘酮给药剂量不足及在心肺复苏过程中给药较晚是两个混杂因素。有必要进行评估这些药物的前瞻性研究。
