Drug Found Most Effective for Cardiac Arrest

A study has shown that the anti-arrhythmic agent amiodarone is almost twice as effective as lidocaine in keeping cardiac arrest patients alive until arrival at a hospital emergency department (ED). The finding was reported in the March 21, 2002, issue of The New England Journal of Medicine.

Fewer than 10% of cardiac arrest patients in North America survive. Many cases of cardiac arrest are caused by ventricular fibrillation (VF). Patients with VF will die unless they receive cardiopulmonary resuscitation and defibrillation within five to seven minutes. If defibrillation is not immediately effective, the next step is to use an anti-arrhythmic drug. Traditionally, lidocaine has been that drug.

The new study, the first to compare the effectiveness of lidocaine versus amiodarone, was conducted by researchers at St. Michael's Hospital at the University of Toronto (Canada). They followed 347 randomized patients who had suffered cardiac arrest and had received one of the two drugs, administered by paramedics at the Toronto Emergency Medical System. The results showed that almost twice as many patients survived to be admitted to the hospital when they received amiodarone compared to the patients who received lidocaine. The researchers say a much larger trial is needed to verify whether more patients receiving amiodarone go on to survive discharge from the hospital.

"Cardiac arrest requires prompt action, both by ambulance personnel and emergency department staff and physicians,” said Dr. Dan Cass, co-author of the study and chief, department of emergency medicine, at St. Michael's Hospital. "Our goal is to provide clear, scientifically-based guidelines as to the most effective possible drug treatment should electrical defibrillation fail.”




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