Cardiac arrest: amiodarone increased survival to hospital admission but not discharge.

Clinical bottom line (level 1b)

  1. Patients with an out-of-hospital cardiac arrest in ventricular fibrillation who were given amiodarone, were more likely to survive to hospital admission than those given placebo (NNT = 11 at unknown) .
  2. Survival to discharge was not clearly different between the two groups
Kudenchuk et al: New England Journal of Medicine 1999; 341: 871-878
Expires October 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: 21 paramedic base stations and 15 hospitals, USA: Seattle, King County

504 patients (aged mean 66 years, 77% male) nontraumatic out-of-hospital cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia

Excluded if
  • not adults
  • <3 precordial shocks given
  • intravenous access had not been established
  • paramedics not on scene with the study drug or placebo
  • spontaneous conversion of arrhythmia


    • Control Group: (n = 258, 258 analysed): placebo- polysorbate 80 (diluent of amiodarone)
    Experimental Group: (n = 246, 246 analysed): 300 mg amiodarone
    Advanced life support was given by paramedics at the scene. 1 mg epinephrine i.v. given before study drug or placebo. The therapy (study drug or placebo) was diluted with 5% dextrose in water to a volume of 20 ml and the then injected rapidly into a peripheral vein that was simultaneously being infused with 5% dextrose and water, while cardiopulmonary resuscitation was being continued. Further treatment did not differ between the two groups.
    100% followed for ?
    Outcome notes:
    • survival to hospital admission : with a spontaneously perfusing rhythm. Sufficiently stable, organised rhythm and blood pressure to be assigned a hospital bed.

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    survival to hospital admission minutes 89
    (34.5%)    		 108
    (43.9%)    		 -27%
    (-59% to -2%)    		 -9.41%
    (-17.9% to -0.91%)    		 11
    (6 to 109)
    survival to discharge weeks 34
    (13.2%)    		 33
    (13.4%)    		 -2%
    (-59% to 35%)    		 -0.24%
    (-6.2% to 6.7%)    		 -423
    (NNT = 18 to infinity;
    NNH = 16 to infinity)

    Comments

    1. 27 patients were post-randomisation exclusions. This may have biased the results; no data about their assignment is presented, bar the statement they were 'similar to the eligible patients'.
    2. American Heart Association guidelines were followed for advanced cardiac life support.

    Citation

    1. Kudenchuk PJ, Cobb LA, Copass MK, et al: Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. New England Journal of Medicine 1999; 341: 871-878
    Contributor: Clare Wotton and Bob Phillips, October 1999
    Reviewer: Kenneth Ballew

    Clinical Question.
    Patient cardiac arrest
    Intervention or Exposure amiodarone
    Comparison placebo
    Outcome admission to hospital alive