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ARREST Trial: Amiodarone for Out-of-Hospital Resuscitation of Ventricular Tachycardia or Ventricular Fibrillation

Summary:

  • This trial was pivitol to amiodarone's incorporation into the ACLS algorithm for refractory pulseless ventricular tachycardia (v-tach) or ventricular fibrillation (v-fib).
  • It was the first antiarrhythmic agent to show an improvement in survival to hospital admission and still remains to be the only pharmacologic intervention to be potential beneficial in cardiac arrest from refractory v-tach or v-fib.
  • While this study was not powered to evaluate mortality and despite the above benefits, there was no difference in survival to hospital discharge.

Landmark or Original Studies

  • Kudenchik PJ, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med 1999; 341: 871-878. PubMed
    LOE 1b
    Study Design Prospective, Randomized, Double-blind, Placebo-controlled
    Sample Size N = 500
    Population Adult patients who had out-of-hospital cardiac arrest with ventricular fibrillation or pulseless ventricular tachycardia and could not be resuscitated after receiving >3 defibrillator shock
    Treatments
    • Amiodarone 300 mg IV push (n=246) administered by paramedics on the scene of the cardiac arrest
    • placebo (n=258)
    Other Treatments Epinephrine 1 mg IV
    Follow-Up Hospital Discharge
    Results
    • Primary end point was survival through admission to hospital with a spontaneously perfusing rhythm.
    • 44% of the amiodarone group vs. 34% of the placebo group survival to admission in amiodarone treated patients vs. placebo patients was 1.6 (95% CI=1.1-2.4; p=0.02) and the benefit of amiodarone was observed across subsets of patients.
    • Patients with ventricular fibrillation were more likely to survive to hospital admission (44%) than patients with initial rhythm of asystole or pulseless electrical activity (14%; p<0.001).
    • Patients with transient return of spontaneous circulation before receiving amiodarone or placebo were more likely to survive to be admitted vs. those who remained pulseless before getting study drug.
    • Hypotension was more common with amiodarone (25%; p=0.004).
    • The percentage of patients discharged alive was 13.4% in the amiodarone group and 13.2%% in the placebo group; the study was not powered to detect statistically significant differences in survival till hospital discharge between groups.
    Conclusion Amiodarone resulted in a higher rate of survival to hospital admission in patients with out-of-hospital cardiac arrest and refractory ventricular arrhythmias.
    Location Department of Medicine, University of Washington, Seattle

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MESH Terms & Keywords

  • ARREST Trial, Amiodarone ARREST Trial, Amiodarone Ventricular Tachycardia, Amiodarone Ventricular Fibrillation