Nifekalant versus Amiodarone for Out-Of-Hospital Cardiac Arrest with Refractory Shockable Rhythms; a Post Hoc Analysis
Archives of Academic Emergency Medicine,
Vol. 10 No. 1 (2022),
1 January 2022
,
Page e6
https://doi.org/10.22037/aaem.v10i1.1425
Abstract
Introduction: It is still unclear that which anti-arrhythmics are adequate for treating refractory dysrhythmia. This study aimed to compare amiodarone and nifekalant in management of out-of-hospital cardiac arrest cases with refractory shockable rhythm.
Methods: This was a post hoc analysis of cases registered in a nationwide, multicentre, prospective registry that includes 288 critical care medical centres in Japan. From June 2014 to December 2017, we included all out-of-hospital cardiac arrest patients aged ≥18 years who presented with refractory arrhythmia (sustained ventricular fibrillation or ventricular tachycardia following delivery of at least two defibrillator shocks) and treated with nifekalant or amiodarone after arrival to hospital. Overlap weight was performed to address potential confounding factors.
Results: 1,317 out-of-hospital cardiac arrest patients with refractory arrhythmia were enrolled and categorized into amiodarone (n = 1,275) and nifekalant (n = 42) groups. After overlap weight was performed, there were no significant intergroup differences in increased the rate of admission after return of spontaneous circulation [–5.9% (95%CI: –7.1 to 22.4); p = 0.57], 30-day favourable neurological outcome [0.1% (95%CI: –14 to 13.9); p = 0.99], and 30-day survival [–3.9% (95% CI: –19.8 to 12.0); p = 0.63].
Conclusion: This nationwide study showed that nifekalant was not associated with improved outcomes regarding admission after return of spontaneous circulation, 30-day survival, and 30-day favourable neurological outcome compared with amiodarone.
- Anti-arrhythmia agents
- Cardiopulmonary resuscitation
- Nifekalant
- Ventricular fibrillation
- Ventricular flutter
How to Cite
References
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528.
Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S444-64.
Soar J, Nolan JP, Bottiger BW, Perkins GD, Lott C, Carli P, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015;95:100-47.
Ali MU, Fitzpatrick-Lewis D, Kenny M, Raina P, Atkins DL, Soar J, et al. Effectiveness of antiarrhythmic drugs for shockable cardiac arrest: A systematic review. Resuscitation. 2018;132:63-72.
Sato S, Zamami Y, Imai T, Tanaka S, Koyama T, Niimura T, et al. Meta-analysis of the efficacies of amiodarone and nifekalant in shock-resistant ventricular fibrillation and pulseless ventricular tachycardia. Scientific reports. 2017;7(1):12683.
Aibiki M, Ohshita M, Annen S, Moriyama N, Nakabayashi Y, Takeba J. JRC（Japan Resuscitation Council）Guidelines 2015：Adult Life Support and Post Arrest Care. THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA. 2018;38(3):354-7.
Tagami T, Matsui H, Ishinokami S, Oyanagi M, Kitahashi A, Fukuda R, et al. Amiodarone or nifekalant upon hospital arrival for refractory ventricular fibrillation after out-of-hospital cardiac arrest. Resuscitation. 2016;109:127-32.
Spaite DW, Hanlon T, Criss EA, Valenzuela TD, Wright AL, Keeley KT, et al. Prehospital cardiac arrest: the impact of witnessed collapse and bystander CPR in a metropolitan EMS system with short response times. Annals of Emergency Medicine. 1990;19(11):1264-9.
Hostler D, Thomas EG, Emerson SS, Christenson J, Stiell IG, Rittenberger JC, et al. Increased survival after EMS witnessed cardiac arrest. Observations from the Resuscitation Outcomes Consortium (ROC) Epistry-Cardiac arrest. Resuscitation. 2010;81(7):826-30.
Cummins RO. Emergency medical services and sudden cardiac arrest: the "chain of survival" concept. Annual Review of Public Health. 1993;14:313-33.
Kitamura T, Iwami T, Atsumi T, Endo T, Kanna T, Kuroda Y, et al. The profile of Japanese Association for Acute Medicine - out-of-hospital cardiac arrest registry in 2014-2015. Acute medicine & surgery. 2018;5(3):249-58.
Tagami T, Hirata K, Takeshige T, Matsui J, Takinami M, Satake M, et al. Implementation of the fifth link of the chain of survival concept for out-of-hospital cardiac arrest. Circulation. 2012;126(5):589-97.
Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;1(7905):480-4.
Li F, Thomas LE, Li F. Addressing Extreme Propensity Scores via the Overlap Weights. American journal of epidemiology. 2019;188(1):250-7.
Thomas LE, Li F, Pencina MJ. Overlap Weighting: A Propensity Score Method That Mimics Attributes of a Randomized Clinical Trial. Jama. 2020;323(23):2417-8.
Austin PC. Using the Standardized Difference to Compare the Prevalence of a Binary Variable Between Two Groups in Observational Research. Communications in Statistics - Simulation and Computation. 2009;38(6):1228-34.
Schisterman EF, Cole SR, Platt RW. Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology. 2009;20(4):488-95.
Singh BN, Vaughan Williams EM. The effect of amiodarone, a new anti-anginal drug, on cardiac muscle. British journal of pharmacology. 1970;39(4):657-67.
Pantazopoulos IN, Troupis GT, Pantazopoulos CN, Xanthos TT. Nifekalant in the treatment of life-threatening ventricular tachyarrhythmias. World journal of cardiology. 2011;3(6):169-76.
Nakaya H, Tohse N, Takeda Y, Kanno M. Effects of MS-551, a new class III antiarrhythmic drug, on action potential and membrane currents in rabbit ventricular myocytes. British journal of pharmacology. 1993;109(1):157-63.
Murakawa Y, Yamashita T, Kanese Y, Omata M. Can a class III antiarrhythmic drug improve electrical defibrillation efficacy during ventricular fibrillation? Journal of the American College of Cardiology. 1997;29(3):688-92.
Amino M, Inokuchi S, Nagao K, Nakagawa Y, Yoshioka K, Ikari Y, et al. Nifekalant Hydrochloride and Amiodarone Hydrochloride Result in Similar Improvements for 24-Hour Survival in Cardiopulmonary Arrest Patients: The SOS-KANTO 2012 Study. Journal of cardiovascular pharmacology. 2015;66(6):600-9.
- Abstract Viewed: 1789 times
- pdf Downloaded: 1112 times
Download Statastics
Make a Submission
SJR
COPE
