Abstract P178: High Rates of Survival to Hospital Admission in Patients with Shock-Resistant Out-of-Hospital Ventricular Fibrillation Treated with Nifekalant Hydrochloride, a Novel and Pure Class- III Agent: Report from J-PULSE Registry
Background; Nifekalant hydrochloride (NIF) is a novel intravenous class-III antiarrhythmic agent that purely blocks the K+ channel without inhibiting â-adrenergic receptors. NIF is easily soluble and its half life is relatively short, achieving rapid action (e.g., improvement in the defibrillation threshold) and clearance. The present study was designed to investigate the feasibility of NIF as an adjunct to defibrillation for victims of out-of-hospital cardiac arrest.
Methods; This was a study from the multicenter registry, J-PULSE (Japanese Population-based Utstein-style study with basic and advanced Life Support Education) of four Japanese urban hospitals. Eligible patients were those treated with NIF because of persistent out-of-hospital ventricular fibrillation (VF) following 3 or more precordial shocks and intravenous epinephrine.
Results; Between February 2006 and February 2007, 18 patients (M/F 16/2; mean [±SD] 67±11 years) were enrolled for the study. The median time from dispatch to the first shock was 9.5 minutes, and that from dispatch to NIF administration was 36 minutes. The median usage dose of NIF was 25 mg. The rate of admission alive to the hospital was 72% (n=13), whereas the rate of proarrhythmic torsade de pointes (TdP) owing to QT prolongation was only 5.5% (n=1).
Conclusions; In this multicenter registry, the survival rate to hospital in out-of-hospital VF patients treated with NIF was over 70%. Intravenous administration of NIF seems to be feasible, can be adjunctive to advanced cardiac life-support measures, and therefore further study is warranted.