Key result
Amiodarone plus magnesium reduces post-cross-clamp defibrillation need by ~33 absolute percentage points vs lidocaine.
Why the study?
The high prevalence of ventricular fibrillation after aortic cross-clamp removal in CABG patients and the need to compare effects of lidocaine + magnesium sulfate versus amiodarone + magnesium sulfate for prevention.
RCT (n=74)
Double-blind
Block randomization
No
Absolute Event Rate: 46.7% vs 33.3%
p-value: p=0.240
Amiodarone-magnesium may reduce defibrillation needs after aortic cross-clamp release in CABG; leaves open confirmation in larger trials and effects on clinical outcomes.
Background: The prevalence of ventricular fibrillation after removal of the aortic cross-clamp in patients undergoing coronary artery bypass surgery is about 74%-96% cross-clamp. Defibrillation shock and different types of agents are used to treat ventricular fibrillation (VF). Objectives: This study was aimed to compare the effects of combining lidocaine lidocaine + magnesium sulfate sulfate with amiodarone + magnesium sulfate sulfate in the prevention of reperfusion-induced ventricular fibrillation. Methods: This randomized, double-blinded clinical study included 74 ASA class II and III patients undergoing coronary artery bypass grafting (CABG) in a university-affiliated hospital, Bandar Abbas, Iran, in the years 2015-2016. Patients were divided into two groups based on a random sample table of block. Both groups received magnesium sulfate through the cardiopulmonary cardiopulmonary bypass pump. lidocaine 2% (100 mg) and amiodarone (300 mg) were injected respectively to group lidocaine + magnesium sulfate (LM) and group amiodarone + magnesium sulfate (AM) patients before aortic cross-clamp release. The incidences of arrhythmias were recorded within 30 minutes after release of the aortic sross-clamp (ACC). Additionally, the defibrillation shocks (frequency and level of joules delivered), amount of inotrope agent, and the hemodynamic and arterial blood gas parameters were recorded up to 24 hours post-operatively. Results: There was no significant difference between the two groups in terms of demographic characteristics, ejection fraction, and ASA class. The prevalence of ventricular fibrillation (VF) and atrial fibrillation (Af) 30 minutes after ACC release were 46.7% and 53.3% (P = 0.240) vs. 33.3% and 66.7% (P > 0.999); while, up to 24 hours post-operatively were 60% and 20.0% vs. 0.0% and 0.0% in groups LM and AM respectively. The number of defibrillations in the lidocaine + magnesium sulfate group was significantly higher 57.9% vs. 25% in groups LM and AM respectively (P = 0.004). Conclusions: The use of amiodarone + magnesium sulfate reduces the number of defibrillation following the release of the Aortic cross-clamp compared with lidocaine + magnesium sulfate.
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Kashani et al. (2018) conducted an RCT in Ventricular fibrillation after aortic cross-clamp release during CABG (n=74). Lidocaine + Magnesium sulfate vs. Amiodarone (300 mg) + Magnesium sulfate was evaluated on Ventricular fibrillation within 30 minutes after aortic cross-clamp release (p=0.240). Amiodarone plus magnesium sulfate significantly reduced the need for defibrillation following aortic cross-clamp release compared to lidocaine plus magnesium sulfate (25% vs 57.9%; P=0.004).
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