Impact of early intravenous amiodarone administration on neurological outcome in refractory ventricular fibrillation: retrospective analysis of prospectively collected prehospital data

• Published in: Scandinavian journal of trauma, resuscitation and emergency medicine Vol. 27; no. 1; p. 109
• Main Authors: Lee, Dong Keon, Kim, Yu Jin, Kim, Giwoon, Lee, Choung Ah, Moon, Hyung Jun, Oh, Jaehoon, Yang, Hae Chul, Choi, Han Joo, Oh, Young Taeck, Park, Seung Min
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.12.2019; Springer Nature B.V; BioMed Central; BMC
• Subjects: Age; Aged; Amiodarone; Amiodarone - administration & dosage; Analysis; Anti-Arrhythmia Agents - administration & dosage; Cardiac arrhythmia; Cardiopulmonary Resuscitation; CPR; Drug overdose; Emergency communications systems; Emergency medical care; Emergency medical services; Emergency Medical Services - methods; Emergency services; Female; Fibrillation; Hospital admission and discharge; Hospitalization; Humans; Logistic Models; Male; Medical prognosis; Medical research; Middle Aged; Original Research; Out-of-Hospital Cardiac Arrest - mortality; Outcome Assessment, Health Care; Pathogenesis; Patient Discharge; Patient outcomes; Patients; Potassium; Prognosis; Regression analysis; Response time; Retrospective Studies; Statistical power; Ventricular fibrillation; Ventricular Fibrillation - drug therapy; United States > US; Amiodarone; Prognosis; Cardiopulmonary resuscitation; Emergency medical services; Ventricular fibrillation
• ISSN: 1757-7241; 1757-7241
• DOI: 10.1186/s13049-019-0688-1

The 2015 AHA guidelines recommend that amiodarone should be used for patients with refractory ventricular fibrillation (RVF). However, the optimal time interval between the incoming call and amiodarone administration (call-to-amiodarone administration interval) in RVF patients has not been investigated. We hypothesized that the time elapsed until amiodarone administration could affect the neurological outcome at hospital discharge in patients with RVF. This study is a retrospective analysis of prospectively collected data. One hundred thirty-four patients were enrolled. In univariate logistic regression, the probability of a good neurological outcome at hospital discharge decreased as the time elapsed until amiodarone administration increased (OR 0.89 [95% CI = 0.80-0.99]). In multivariate logistic regression, the patients who were administered amiodarone in less than 20 min showed higher rates of prehospital ROSC, survival at hospital arrival, any ROSC, survival at admission, survival to discharge, and good CPC at hospital discharge. The call-to-amiodarone administration interval of ≤20 min (OR 6.92, 95% CI 1.72-27.80) was the independent factor affecting the neurological outcome at hospital discharge. Early amiodarone administration (≤ 20 min) showed better neurological outcome at hospital discharge for OHCA patients who showed initial ventricular fibrillation and subsequent RVF.