Amiodarone and cardiac arrest: Systematic review and meta-analysis

Ageliki Laina; George Karlis; Aris Liakos; Georgios Georgiopoulos; Dimitrios Oikonomou; Evangelia Kouskouni; Athanasios Chalkias; Theodoros Xanthos

doi:10.1016/j.ijcard.2016.07.138

Amiodarone and cardiac arrest: Systematic review and meta-analysis

Int J Cardiol. 2016 Oct 15:221:780-8. doi: 10.1016/j.ijcard.2016.07.138. Epub 2016 Jul 9.

Authors

Ageliki Laina¹, George Karlis², Aris Liakos³, Georgios Georgiopoulos⁴, Dimitrios Oikonomou⁵, Evangelia Kouskouni⁶, Athanasios Chalkias⁷, Theodoros Xanthos⁸

Affiliations

¹ National and Kapodistrian University of Athens, Medical School, M.Sc. "Cardiopulmonary Resuscitation, Athens, Greece; A. Fleming General Hospital, Department of Internal Medicine, Athens, Greece.
² National and Kapodistrian University of Athens, Medical School, Evaggelismos Hospital, 1st Department of Intensive Care Medicine, Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
³ Aristotle University of Thessaloniki, Hippokratio General Hospital, Clinical Research and Evidence-Based Medicine Unit, Thessaloniki, Greece.
⁴ National and Kapodistrian University of Athens, Medical School, Department of Clinical Therapeutics, Vascular Laboratory, Athens, Greece.
⁵ A. Fleming General Hospital, Department of Internal Medicine, Athens, Greece.
⁶ National and Kapodistrian University of Athens, Medical School, M.Sc. "Cardiopulmonary Resuscitation, Athens, Greece.
⁷ National and Kapodistrian University of Athens, Medical School, M.Sc. "Cardiopulmonary Resuscitation, Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece. Electronic address: thanoschalkias@yahoo.gr.
⁸ Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece; European University Cyprus, School of Medicine, Nicosia, Cyprus.

PMID: 27434349
DOI: 10.1016/j.ijcard.2016.07.138

Abstract

Introduction: The 2015 Guidelines for Resuscitation recommend amiodarone as the antiarrhythmic drug of choice in the treatment of resistant ventricular fibrillation or pulseless ventricular tachycardia. We reviewed the effects of amiodarone on survival and neurological outcome after cardiac arrest.

Methods: We systematically searched MEDLINE and Cochrane Library from 1940 to March 2016 without language restrictions. Randomized control trials (RCTs) and observational studies were selected.

Results: Our search initially identified 1663 studies, 1458 from MEDLINE and 205 from Cochrane Library. Of them, 4 randomized controlled studies and 6 observational studies met the inclusion criteria and were selected for further review. Three randomized studies were included in the meta-analysis. Amiodarone significantly improves survival to hospital admission (OR=1.402, 95% CI: 1.068-1.840, Z=2.43, P=0.015), but neither survival to hospital discharge (RR=0.850, 95% CI: 0.631-1.144, Z=1.07, P=0.284) nor neurological outcome compared to placebo or nifekalant (OR=1.114, 95% CI: 0.923-1.345, Z=1.12, P=0.475).

Conclusions: Amiodarone significantly improves survival to hospital admission. However there is no benefit of amiodarone in survival to discharge or neurological outcomes compared to placebo or other antiarrhythmics.

Keywords: Amiodarone; Cardiac arrest; Cardiopulmonary resuscitation; Meta-analysis; Systematic review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Amiodarone / therapeutic use*
Anti-Arrhythmia Agents / therapeutic use*
Heart Arrest / diagnosis
Heart Arrest / drug therapy*
Heart Arrest / mortality*
Humans
Observational Studies as Topic / methods
Patient Admission / trends
Patient Discharge / trends
Randomized Controlled Trials as Topic / methods
Survival Rate / trends

Substances

Anti-Arrhythmia Agents
Amiodarone