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J Clin Med. 2019 Feb 13;8(2). pii: E244. doi: 10.3390/jcm8020244.

Effect of Prophylactic Amiodarone Infusion on the Recurrence of Ventricular Arrhythmias in Out-of-Hospital Cardiac Arrest Survivors: A Propensity-Matched Analysis.

Author information

1
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju 61469, Korea. bbukkuk@hanmail.net.
2
Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea. ycs1005@catholic.ac.kr.
3
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul 05505, Korea. yjkim.em@gmail.com.
4
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul 05505, Korea. chrisryoo@naver.com.
5
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul 05505, Korea. kslim@amc.seoul.kr.
6
Department of Internal Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul 05505, Korea. gbnam@amc.seoul.kr.
7
Department of Emergency Medicine, College of Medicine, Korea University, Seoul 02841, Korea. wonpia73@naver.com.
8
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul 05505, Korea. icarusksj@korea.ac.kr.

Abstract

Amiodarone is recommended for shock-refractory ventricular arrhythmia during resuscitation; however, it is unknown whether amiodarone is effective for preventing ventricular arrhythmia recurrence in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). We investigated the effectiveness of prophylactic amiodarone in preventing ventricular arrhythmia recurrence in OHCA survivors. Data of consecutive adult non-traumatic OHCA survivors treated with TTM between 2010 and 2016 were extracted from prospective cardiac arrest registries of four tertiary care hospitals. The prophylactic amiodarone group was matched in a 1:1 ratio by using propensity scores. The primary outcome was ventricular arrhythmia recurrence requiring defibrillation during TTM. Among 295 patients with an initially shockable rhythm and 149 patients with initially non-shockable-turned-shockable rhythm, 124 patients (27.9%) received prophylactic amiodarone infusion. The incidence of ventricular arrhythmia recurrence was 11.26% (50/444). Multivariate analysis showed prophylactic amiodarone therapy to be the independent factor associated with ventricular arrhythmia recurrence (odds ratio 1.95, 95% CI 1.04⁻3.65, p = 0.04), however, no such association was observed (odds ratio 1.32, 95% CI 0.57⁻3.04, p = 0.51) after propensity score matching. In this propensity-score-matched study, prophylactic amiodarone infusion had no effect on preventing ventricular arrhythmia recurrence in OHCA survivors with shockable cardiac arrest. Prophylactic amiodarone administration must be considered carefully.

KEYWORDS:

amiodarone; cardiac arrest; outcome; targeted temperature management; ventricular arrhythmia

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