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  1. Jim Wardrope1,
  2. Philip Davies2,
  3. Anthony Mattick3
  1. 1Accident and Emergency Department, Northern General Hospital, Herries Road, Sheffield S5 7AU
  2. 2Emergency Department, Bristol Royal Infirmary
  3. 3Emergency Department, Edinburgh Royal Infirmary
  1. Correspondence to: Mr Wardrope, Associate Editor

https://doi.org/10.1136/emj.17.2.130

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    Edited by Jim Wardrope; this scan coordinated by Philip Davies and Anthony Mattick

    Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation

    P Kudenchuk, L A Cobb, M Copass, et al.N Engl J Med1999;341:871–8

    Overview—The role of antiarrhythmic drugs in resuscitation after out-of-hospital cardiac arrest has not been determined in randomised controlled trials. The authors conducted such a study looking at the efficacy of amiodarone in such circumstances.

    Design—A randomised double blind, placebo controlled trial. Patients who had a cardiac arrest with ventricular fibrillation (or pulseless ventricular tachycardia) and who had not been resuscitated after three or more precordial shocks were randomly assigned to receive 300 mg of amiodarone (246 patients) or placebo (258 patients). Before administration of the study vial the patients were intubated, intravenous access obtained, and 1 mg of adrenaline (epinephrine) given intravenously. Thereafter the patients received standard care en route to hospital whatever group they were assigned.

    Outcome measures—The primary end point was admission to hospital with a spontaneously perfusing rhythm.

    Results—Recipients of amiodarone were more likely to survive to hospital (44% compared with 34% of the placebo group, p=0.03). The benefit was consistent among all subgroups and at all times of drug administration. There was little difference between the groups in patients surviving to hospital discharge.

    Conclusion—Patients with out-of-hospital cardiac arrest due to refractory ventricular arrhythmias who were treated with amiodarone had a higher rate of survival to hospital admission.

    Critique—The study looked at an important and specific question that had not been tested by a randomised controlled study. A large number of patients (504) were analysed in the trial with similar clinical profiles in both groups. However, a further 160 patients were initially eligible but not entered into the analysis. These included patients who were successfully cardioverted before the study drug could be given. Such exclusions were clearly acceptable. However, no numbers are given of exclusions because of “technical …

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