Department of Cardiology, Tokai University School of Medicine, Isehara, Japan.
J Cardiovasc Pharmacol. 2010 Apr;55(4):391-8. doi: 10.1097/FJC.0b013e3181d3dcc7.
In Japan, intravenous nifekalant (NIF) was often used for direct current cardioversion-resistant ventricular fibrillation (VF), until the use of intravenous amiodarone (AMD) was approved in 2007. The defibrillatory efficacy of NIF and AMD has thus far not been compared for resuscitation.
Between August 2007 and April 2009, 403 consecutive out-of-hospital patients with cardiopulmonary arrest were transferred to the Emergency Medical Service of Tokai University. Of these, 30 patients with first defibrillation failure or VF recurrence were enrolled for this NIF/AMD study. The final defibrillation success (and hospital survival rate) was 67% (10/15) in the AMD and 47% (7/15) in the NIF group. The discharge survival rate was 53% (8/15) in the AMD and 21% (4/15) in the NIF group (P = 0.06). Notably, all 4 survivors in the NIF group could take up normal daily life again, whereas this was restricted to only 2 patients from the 11 survivors in the AMD group. The difference is probably partly attributable to longer time from AMD administration to defibrillation success compared with NIF. In the cases of defibrillation failure, VF continued in 4/8 by NIF, however, asystole or pulseless electrical activity occurred in 4/5 patients by AMD.
AMD may be borderline superior over NIF to facilitate defibrillation in out-of-hospital patients with cardiopulmonary arrest. However, from the view point of preservation of brain function, NIF is not inferior to AMD for CPR.
在日本，静脉注射尼非卡兰（NIF）常被用于直流电转复无效的心室颤动（VF），直到 2007 年批准使用静脉注射胺碘酮（AMD）。到目前为止，还没有比较过 NIF 和 AMD 在复苏中的除颤效果。
2007 年 8 月至 2009 年 4 月，403 例院外心肺骤停患者被转至东海大学急救医疗服务中心。其中，30 例首次除颤失败或 VF 复发的患者被纳入本项 NIF/AMD 研究。AMD 组的最终除颤成功（和出院存活率）为 67%（10/15），NIF 组为 47%（7/15）。AMD 组的出院存活率为 53%（8/15），NIF 组为 21%（4/15）（P = 0.06）。值得注意的是，NIF 组的所有 4 例存活患者都能恢复正常的日常生活，而 AMD 组的 11 例存活患者中只有 2 例能做到这一点。这种差异可能部分归因于与 NIF 相比，AMD 给药至除颤成功的时间更长。在除颤失败的情况下，NIF 使 4/8 例继续发生 VF，而 AMD 使 4/5 例发生停搏或无脉电活动。
AMD 可能在一定程度上优于 NIF，有助于院外心肺骤停患者除颤。然而，从脑功能保护的角度来看，NIF 并不逊于 AMD 用于 CPR。
