University of Washington School of Medicine, Seattle, WA, USA.
Acad Emerg Med. 2010 Jun;17(6):617-23. doi: 10.1111/j.1553-2712.2010.00763.x.
Procainamide is an antiarrhythmic drug of unproven efficacy in cardiac arrest. The association between procainamide and survival from out-of-hospital cardiac arrest was investigated to better determine the drug's potential role in resuscitation.
The authors conducted a 10-year study of all witnessed, out-of-hospital, ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) cardiac arrests treated by emergency medical services (EMS) in King County, Washington. Patients were considered eligible for procainamide if they received more than three defibrillation shocks and intravenous (IV) bolus lidocaine. Four logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CI) describing the relationship between procainamide and survival.
Of the 665 eligible patients, 176 received procainamide, and 489 did not. On average, procainamide recipients received more shocks and pharmacologic interventions and had lengthier resuscitations. Adjusted for their clinical and resuscitation characteristics, procainamide recipients had a lower likelihood of survival to hospital discharge (OR = 0.52; 95% CI = 0.36 to 0.75). Further adjustment for receipt of other cardiac medications during resuscitation negated this apparent adverse association (OR = 1.02; 95% CI = 0.66 to 1.57).
In this observational study of out-of-hospital VF and pulseless VT arrest, procainamide as second-line antiarrhythmic treatment was not associated with survival in models attempting to best account for confounding. The results suggest that procainamide, as administered in this investigation, does not have a large impact on outcome, but cannot eliminate the possibility of a smaller, clinically relevant effect on survival.
普鲁卡因胺是一种抗心律失常药物，其在心脏骤停中的疗效尚未得到证实。本研究旨在探讨普鲁卡因胺与院外心脏骤停患者生存之间的关系，以更好地确定该药物在心搏骤停复苏中的潜在作用。
作者对华盛顿州金县所有经急救医疗服务（EMS）治疗的目击、院外、心室颤动（VF）或无脉性室性心动过速（VT）心脏骤停患者进行了一项为期 10 年的研究。如果患者接受了超过 3 次除颤电击和静脉（IV）推注利多卡因，则认为其适合使用普鲁卡因胺。使用 4 个逻辑回归模型计算描述普鲁卡因胺与生存之间关系的优势比（OR）和 95%置信区间（CI）。
在 665 名符合条件的患者中，176 名患者接受了普鲁卡因胺治疗，489 名患者未接受普鲁卡因胺治疗。平均而言，普鲁卡因胺组患者接受了更多的电击和药物干预，且复苏时间更长。调整其临床和复苏特征后，普鲁卡因胺组患者存活至出院的可能性较低（OR=0.52；95%CI=0.36 至 0.75）。在复苏期间接受其他心脏药物治疗的调整进一步否定了这种明显的不良关联（OR=1.02；95%CI=0.66 至 1.57）。
在本项观察性研究中，对于院外 VF 和无脉性 VT 骤停，在试图最佳控制混杂因素的模型中，作为二线抗心律失常治疗的普鲁卡因胺与生存无关。结果表明，在本研究中给予的普鲁卡因胺对结局没有重大影响，但不能排除其对生存有较小但具有临床意义的影响。
