Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Amiodarone for Cardiac Arrest in the 2010 ACLS – Part I


Those of us, who use amiodarone can hold our heads up high, because we do not use that placebo that I wrote about in Lidocaine for Cardiac Arrest Part I, Part II, and Part III.

Antiarrhythmics
There is no evidence that any antiarrhythmic drug given routinely during human cardiac arrest increases survival to hospital discharge. Amiodarone, however, has been shown to increase short-term survival to hospital admission when compared with placebo or lidocaine.[1]

In other words, there is still no good reason to be giving amiodarone, or any other antiarrhythmic.

What else does the AHA (American Heart Association) have to say about amiodarone?

Amiodarone
IV amiodarone affects sodium, potassium, and calcium channels and has α- and β-adrenergic blocking properties.[1]

We still do not know what kind of effect amiodarone has on survival to discharge, but we are optimistic.

Why optimistic?

Better to do something harmful, than to do nothing and appear ineffective.

How does the way amiodarone affects sodium, potassium, and calcium channels improve the resuscitation of the heart?

How do the α- and β-adrenergic blocking properties of amiodarone improve the resuscitation of the heart?

Not that we have a good reason to be giving the α- and β-adrenergic drug epinephrine to treat cardiac arrest, but why counter that with the α- and β-adrenergic blocking properties of amiodarone?

Are we intentionally countering the α- and β-adrenergic effects of epinephrine with the α- and β-adrenergic blocking properties of amiodarone?

With so many diverse effects, should we be using amiodarone for everyone?

For hyperkalemic and acidotic arrests, do we want to be manipulating the calcium and sodium channels?

To be continued in Amiodarone for Cardiac Arrest in the 2010 ACLS – Part II and later in Amiodarone for Cardiac Arrest in the 2010 ACLS – Part III.

Footnotes:

[1] Amiodarone
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 8.2: Management of Cardiac Arrest
Medications for Arrest Rhythms
Antiarrhythmics
Free Full Text Article with links to Free Full Text PDF download

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Comments

  1. How do the α- and β-adrenergic blocking properties of amiodarone improve the resuscitation of the heart?

    Because it blunts the effect of all of the Epinephrine we gave them?

    • Christopher,

      That is one possibility.

      We are routinely and indiscriminately giving drugs with many diverse effects, while we are ignoring the possibility for harm.

      Eventually we may use an approach that is more appropriate, an approach that considers what is best for the patient, rather than what is best for the ego of the doctor/nurse/paramedic/et cetera.

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