Key result
Nifekalant and amiodarone (≤150 mg) were associated with significantly higher odds of survival to admission compared to lidocaine (OR 3.21, 95% CI 1.38-7.44 and OR 3.09, 95% CI 1.55-6.16, respectively).
Why the study?
Do nifekalant or amiodarone improve survival compared to lidocaine in adult patients with out-of-hospital cardiac arrest and shock-resistant VT/VF?
Cohort (n=500)
Yes
Do nifekalant or amiodarone improve survival compared to lidocaine in adult patients with out-of-hospital cardiac arrest and shock-resistant VT/VF?
Odds Ratio: 3.21 (95% CI 1.38–7.44)
p-value: p=<0.01
Nifekalant and amiodarone are associated with improved survival to admission and 24-hour survival compared to lidocaine in patients with out-of-hospital cardiac arrest and shock-resistant VT/VF.
NIF and AMD may yield similar 24-h survival in refractory VT/VF; leaves open optimal choice pending randomized trials.
BACKGROUND: Amiodarone (AMD), nifekalant (NIF), and lidocaine (LID) hydrochlorides are widely used for ventricular tachycardia/fibrillation (VT/VF). This study retrospectively investigated the NIF potency and the differential effects of 2 initial AMD doses (≤150 mg or 300 mg) in the Japanese SOS-KANTO 2012 study population. METHODS AND RESULTS: From 16,164 out-of-hospital cardiac arrest cases, 500 adult patients using a single antiarrhythmic drug for shock-resistant VT/VF were enrolled and categorized into 4 groups (73 LID, 47 NIF, 173 AMD-≤150, and 207 AMD-300). Multivariate analyses evaluated the outcomes of NIF, AMD-≤150, or AMD-300 groups versus LID group. Odds ratios (ORs) for survival to admission were 3.21 [95% confidence interval (CI): 1.38-7.44, P < 0.01] in NIF and 3.09 (95% CI: 1.55-6.16, P < 0.01) in AMD-≤150 groups and significantly higher than those of the LID group. However, the OR was 1.78 (95% CI: 0.90-3.51, P = 0.10) in AMD-300 group and was not significant than LID group. ORs for 24-hour survival were 6.68 in NIF, 4.86 in AMD-≤150, and 2.97 in AMD-300, being significantly higher in these groups. CONCLUSIONS: NIF and AMD result in similar improvements for 24-hour survival in cardiopulmonary arrest patients, and this suggest the necessity of a randomized control study.
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Amino et al. (2015) conducted a cohort in Out-of-hospital cardiac arrest with shock-resistant VT/VF (n=500). Nifekalant or Amiodarone vs. Lidocaine was evaluated on Survival to admission (OR 3.21, 95% CI 1.38-7.44, p=<0.01). Nifekalant and amiodarone (≤150 mg) were associated with significantly higher odds of survival to admission compared to lidocaine (OR 3.21, 95% CI 1.38-7.44 and OR 3.09, 95% CI 1.55-6.16, respectively).
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