Extracts from 2010 CPR & ECC Science – Medications – Amiodarone
by Alan Batt. Last modified: 21/08/14
In this series of posts we will take extracts on medications and interventions from the 2010 CPR & ECC Guidelines and provide the links to their PubMed abstracts where available. We will also indicate which ones are available through open-access. A similar format is available directly through Circulation online (link below), but this does not utilise opening links through Read by QxMD.
IV amiodarone affects sodium, potassium, and calcium channels and has a- and b-adrenergic blocking properties. It can be considered for treatment of VF or pulseless VT unresponsive to shock delivery, CPR, and a vasopressor. In blinded randomized controlled clinical trials in adults with refractory VF/pulseless VT in the out-of-hospital setting,134,136 paramedic administration of amiodarone (300 mg134 or 5 mg/kg136) improved hospital admission rates when compared with administration of placebo134 or 1.5 mg/kg of lidocaine.136
Additional studies283–287 documented consistent improvement in termination of arrhythmias when amiodarone was given to humans or animals with VF or hemodynamically unstable VT. A higher incidence of bradycardia and hypotension was reported for amiodarone in one out-of-hospital study.134 A canine study288 noted that administration of a vasoconstrictor before amiodarone prevented hypotension. The adverse hemodynamic effects of the IV formulation of amiodarone are attributed to vasoactive solvents (polysorbate 80 and benzyl alcohol). When administered in the absence of these solvents, an analysis of the combined data of 4 prospective clinical trials of patients with VT (some hemodynamically unstable) showed that amiodarone produced no more hypotension than lidocaine.286
A formulation of IV amiodarone without these vasoactive solvents was approved for use in the United States. Amiodarone may be considered for VF or pulseless VT unresponsive to CPR, defibrillation, and a vasopressor therapy (Class IIb, LOE B). An initial dose of 300 mg IV/IO can be followed by 1 dose of 150 mg IV/IO. Although anecdotally administered IO without known adverse effects, there is limited experience with amiodarone given by this route.
134.Kudenchuk PJ1, Cobb LA, Copass MK, Cummins RO, Doherty AM, Fahrenbruch CE, Hallstrom AP, Murray WA, Olsufka M, Walsh T. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med. 1999 Sep 16;341(12):871-8. PMID: 10486418.
136.Dorian P1, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002 Mar 21;346(12):884-90. PMID: 11907287.
283.Skrifvars MB1, Kuisma M, Boyd J, Määttä T, Repo J, Rosenberg PH, Castren M. The use of undiluted amiodarone in the management of out-of-hospital cardiac arrest. Acta Anaesthesiol Scand. 2004 May;48(5):582-7. PMID: 15101852.
285.Levine JH1, Massumi A, Scheinman MM, Winkle RA, Platia EV, Chilson DA, Gomes A, Woosley RL. Intravenous amiodarone for recurrent sustained hypotensive ventricular tachyarrhythmias. Intravenous Amiodarone Multicenter Trial Group. J Am Coll Cardiol. 1996 Jan;27(1):67-75. PMID: 8522712.
286.Somberg JC1, Bailin SJ, Haffajee CI, Paladino WP, Kerin NZ, Bridges D, Timar S, Molnar J; Amio-Aqueous Investigators. Intravenous lidocaine versus intravenous amiodarone (in a new aqueous formulation) for incessant ventricular tachycardia. Am J Cardiol. 2002 Oct 15;90(8):853-9. PMID: 12372573.
287.Somberg JC1, Timar S, Bailin SJ, Lakatos F, Haffajee CI, Tarjan J, Paladino WP, Sarosi I, Kerin NZ, Borbola J, Bridges DE, Molnar J; Amio-Aqueous Investigators. Lack of a hypotensive effect with rapid administration of a new aqueous formulation of intravenous amiodarone. Am J Cardiol. 2004 Mar 1;93(5):576-81. PMID: 14996582.
288.Paiva EF1, Perondi MB, Kern KB, Berg RA, Timerman S, Cardoso LF, Ramirez JA. Effect of amiodarone on haemodynamics during cardiopulmonary resuscitation in a canine model of resistant ventricular fibrillation. Resuscitation. 2003 Aug;58(2):203-8. PMID: 12909383.
The following two tabs change content below.Paramedic, educator, researcherAlan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.
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Extracts from 2010 CPR & ECC Science – Medications – Amiodarone
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