Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Curr Opin Crit Care. 2018 Jun;24(3):138-142. doi: 10.1097/MCC.0000000000000498.
The optimal antiarrhythmic drug therapy (amiodarone or lidocaine) in the treatment of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) cardiac arrest that is refractory to defibrillation is uncertain. This article reviews the evidence for and against these drugs, alternatives treatments for refractory VF/pVT and aims to define the role of antiarrhythmic drugs during cardiopulmonary resuscitation (CPR).
A large randomized controlled trial that compared amiodarone, lidocaine and saline 0.9% sodium chloride for the treatment of refractory VF/pVT out-of-hospital cardiac arrest reported no difference in survival to hospital discharge or neurological outcome. In patients with witnessed arrest, survival was improved with antiarrhythmic drugs compared to saline.
The benefit of antiarrhythmic drugs appears to be for those patients in whom initial early CPR and defibrillation attempts fail and the antiarrhythmic drug is given early. There does not appear to be any clear survival benefit for any one particular drug and other factors such as availability and cost should be considered when deciding which drug to use. Furthermore, other interventions (e.g. percutaneous coronary intervention and extra-corporeal CPR) may provide additional survival benefit when defibrillation attempts and antiarrhythmic drugs are not effective.
对于电击除颤无效的室颤/无脉性室速（VF/pVT）心脏骤停，最佳的抗心律失常药物治疗（胺碘酮或利多卡因）仍不确定。本文综述了这两种药物的相关证据，包括其在难治性 VF/pVT 中的替代治疗方法，并旨在确定抗心律失常药物在心肺复苏（CPR）期间的作用。
一项比较胺碘酮、利多卡因和生理盐水（0.9%氯化钠）治疗院外难治性 VF/pVT 心脏骤停的大型随机对照试验报告称，在出院存活率或神经功能预后方面，三种药物之间无差异。在有目击者的心脏骤停患者中，与生理盐水相比，抗心律失常药物可提高存活率。
抗心律失常药物的益处似乎仅适用于那些初始早期心肺复苏和除颤尝试失败且早期给予抗心律失常药物的患者。对于任何一种特定药物，似乎都没有明显的生存获益，在决定使用哪种药物时，还应考虑其他因素，如可用性和成本。此外，当除颤尝试和抗心律失常药物无效时，其他干预措施（如经皮冠状动脉介入治疗和体外心肺复苏）可能会提供额外的生存获益。
