Abstract 10584: The Effect of Nifekalant Hydrochloride for Patients With Refractory Ventricular Fibrillation Outside the Hospital (A SOS-KANTO 2012 Observational Study Interim Report)
BACKGROUND: There is insufficient evidence that intravenous amiodarone during cardiopulmonary resuscitation (CPR) improve survival to discharge for patients with out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF). Nifekalant hydrochloride, developed in Japan, is a novel class III antiarrhythmic agent according to the Vaughan Williams classification, similar to amiodarone. When compared with amiodarone, nifekalant has no negative inotropic effect on myocardial contractility because of a pure IKr blocking action and clearance with a short half life.
METHODS: We conducted a survey of survivors of OHCA in the Kanto region of Japan (SOS-KANTO 2012), a prospective, multicenter, observational study. From the data of SOS-KANTO 2012, adult patients who were recorded VF during CPR by emergency medical service (EMS)responders were included. The primary endpoint was survival at 30 days after cardiac arrest.
RESULTS: Of the 5,645 adult patients with OHCA, 464 (8.2%) were VF; 425 were recorded as an initial cardiac arrest on EMS responder arrival and 39 as a conversion from other arrest rhythms during CPR by EMS responders. Of these VF patients, 40.3% (187/464) continued VF on ER arrival, and were treated with intravenous administration of single use of class III antiarrhythmic agents by emergency physicians; 28 were administered nifekalant and 159 amiodarone. Two groups had similar ROSC rate (50.0% in the nifekalant group vs. 47.2% in the amiodarone group) and post cardiac arrest care with therapeutic hypothermia and emergency coronary intervention. In the patients who achieved ROSC, the nifekalant group had a significantly higher 30-day survival than the amiodarone group (50.0% vs. 20.0%, p=0.02), and 30-day favorable neurological outcome was similar in the two groups (28.6% vs. 17.3%, p=0.45).
CONCLUSION: Intravenous administration of nifekalant resulted in better 30-day survival than that of amiodarone for OHCA patients with refractory VF. Additional data accumulation is necessary.
- © 2013 by American Heart Association, Inc.