Effects of intra-resuscitation antiarrhythmic administration on rearrest occurrence and intra-resuscitation ECG characteristics in the ROC ALPS trial
| Autor: | Tom P. Aufderheide, Stephanie Zellner, Noah Kime, Allison C Koller, Matthew L Sundermann, Jason E. Buick, Sheldon Cheskes, David D Salcido, Robert H. Schmicker, Dana Zive, Brian Grunau, Heather Herren, James J. Menegazzi, Jack Nuttall |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Canada medicine.medical_specialty Resuscitation Lidocaine Amiodarone Context (language use) 030204 cardiovascular system & hematology Emergency Nursing Return of spontaneous circulation Article Defibrillation threshold Electrocardiography 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Aged Retrospective Studies business.industry 030208 emergency & critical care medicine Rearrest Middle Aged medicine.disease Cardiopulmonary Resuscitation United States 3. Good health Survival Rate Ventricular Fibrillation Ventricular fibrillation Emergency Medicine Cardiology Female Cardiology and Cardiovascular Medicine business Anti-Arrhythmia Agents Out-of-Hospital Cardiac Arrest Follow-Up Studies medicine.drug |
| Zdroj: | Publons |
| ISSN: | 0300-9572 |
| DOI: | 10.1016/j.resuscitation.2018.05.028 |
| Popis: | Background Intra-resuscitation antiarrhythmic drugs may improve resuscitation outcomes, in part by avoiding rearrest, a condition associated with poor out-of-hospital cardiac arrest (OHCA) outcomes. However, antiarrhythmics may also alter defibrillation threshold. The objective of this study was to investigate the relationship between rearrest and intra-resuscitation antiarrhythmic drugs in the context of the Resuscitation Outcomes Consortium (ROC) amiodarone, lidocaine, and placebo (ALPS) trial. Hypothesis Rearrest rates would be lower in cases treated with amiodarone or lidocaine, versus saline placebo, prior to first return of spontaneous circulation (ROSC). We also hypothesized antiarrhythmic effects would be quantifiable through analysis of the prehospital electrocardiogram. Methods We conducted a secondary analysis of the ROC ALPS trial. Cases that first achieved prehospital ROSC after randomized administration of study drug were included in the analysis. Rearrest, defined as loss of pulses following ROSC, was ascertained from emergency medical services records. Rearrest rate was calculated overall, as well as by ALPS treatment group. Multivariable logistic regression models were constructed to assess the association between treatment group and rearrest, as well as rearrest and both survival to hospital discharge and survival with neurologic function. Amplitude spectrum area, median slope, and centroid frequency of the ventricular fibrillation (VF) ECG were calculated and compared across treatment groups. Results A total of 1144 (40.4%) cases with study drug prior to first ROSC were included. Rearrest rate was 44.0% overall; 42.9% for placebo, 45.7% for lidocaine, and 43.0% for amiodarone. In multivariable logistic regression models, ALPS treatment group was not associated with rearrest, though rearrest was associated with poor survival and neurologic outcomes. AMSA and median slope measures of the first available VF were associated with rearrest case status, while median slope and centroid frequency were associated with ALPS treatment group. Conclusion Rearrest rates did not differ between antiarrhythmic and placebo treatment groups. ECG waveform characteristics were correlated with treatment group and rearrest. Rearrest was inversely associated with survival and neurologic outcomes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect