Abstract 281: Antiarrhythmics for Out-of-Hospital Cardiac Arrest Resuscitation: A Systematic Review and Meta-analysis
Introduction: The evidence for the use of antiarrhythmics in out-of-hospital cardiac arrest (OHCA) resuscitation is inconclusive. We systematically reviewed the existing literature to assess the efficacy and effectiveness of antiarrhythmics for adult OHCA.
Methods: We searched in MEDLINE, EMBASE, and the Cochrane Library from inception to June 2013 for randomised controlled trials (RCTs) and observational studies evaluating amiodarone, lidocaine, and magnesium sulfate in adult OHCA patients. Meta-analyses were performed using random effects modeling on RCTs and observational studies. Sensitivity analyses were performed stratifying by study design. The primary outcome was survival to discharge and the secondary outcomes were return of spontaneous circulation (ROSC), survival to admission, and neurological outcome.
Results: Nine studies (n=2904) met our inclusion criteria, of which five were RCTs (n=1132) and four were observational studies (n=1772): one RCT compared amiodarone to placebo (n=504), one RCT compared amiodarone to lidocaine (n=347), three RCTs (n=281) compared magnesium to placebo, two observational studies (n=1366) compared amiodarone to no/other antiarrhythmic, and two observational studies (n=406) compared lidocaine to no/other antiarrhythmic. There were no differences in survival to discharge or neurological outcome in any comparison group, including sensitivity analyses. Amiodarone was associated with improved survival to admission compared to placebo [one RCT; RR 1.27, 95% CI 1.02-1.59; RD 0.09, 95% CI 0.01-0.18; NNT 11, 95% CI 6-113] and lidocaine [one RCT, RR 1.90, 95% CI 1.16-3.11; RD 0.11, 95% CI 0.03-0.19, NNT 9, 95% CI 5-36]. There were no differences in outcomes between magnesium vs. placebo in three RCTs, and amiodarone vs. no/other antiarrhythmic and lidocaine vs. no/other antiarrhythmic in observational studies.
Conclusions: There was no benefit of antiarrhythmics in survival to discharge or neurological outcomes among adults with OHCA. Amiodarone was associated with improved rates of survival to admission compared to lidocaine and placebo; however, data comes from only one RCT each. Future placebo-controlled trials are needed to evaluate the efficacy of antiarrhythmics in OHCA.
Author Disclosures: S. Lin: None. K.D. Dainty: None. I.R. Drennan: None. J.D. Salciccioli: None. P.S. Shah: None. C.P. Ziegler: None. L.J. Morrison: None.
- © 2014 by American Heart Association, Inc.