The impact of time to amiodarone administration on survival from out-of-hospital cardiac arrest

Elizabeth Perry; Emily Nehme; Dion Stub; David Anderson; Ziad Nehme

doi:10.1016/j.resplu.2023.100405

The impact of time to amiodarone administration on survival from out-of-hospital cardiac arrest

Resusc Plus. 2023 Jun 7:14:100405. doi: 10.1016/j.resplu.2023.100405. eCollection 2023 Jun.

Authors

Elizabeth Perry^{1

2}, Emily Nehme^{1

3}, Dion Stub^{1

3

4}, David Anderson^{1

2

3

4}, Ziad Nehme^{1

2

3}

Affiliations

¹ Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.
² Department of Paramedicine, Monash University, Frankston, Victoria, Australia.
³ School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
⁴ Alfred Health, Prahran, Victoria, Australia.

Abstract

Aim: To examine the impact of time to amiodarone administration on survival from shock-refractory Ventricular Fibrillation/pulseless Ventricular Tachycardia (VF/pVT) following out-of-hospital cardiac arrest (OHCA).

Methods: A retrospective cohort study of adult (≥16 years) OHCA patients in shock-refractory VF/pVT (after 3 consecutive defibrillation attempts) of medical aetiology who arrested between January 2010 and December 2019. Time-dependent propensity score matching was used to sequentially match patients who received amiodarone at any given minute of resuscitation with patients eligible to receive amiodarone during the same minute. Log-binomial regression models were used to assess the association between time of amiodarone administration (by quartiles of time-to-matching) and survival outcomes.

Results: A total of 2,026 patients were included, 1,393 (68.8%) of whom received amiodarone with a median (interquartile range) time to administration of 22.0 (18.0-27.0) minutes. Propensity score matching yielded 1,360 matched pairs. Amiodarone administration within 28 minutes of the emergency call was associated with a higher likelihood of return of spontaneous circulation (ROSC) (≤18minutes: RR = 1.03 (95%CI 1.02, 1.04); 19-22minutes: RR = 1.02 (95%CI 1.01, 1.03); 23-27minutes: RR = 1.01 (95%CI 1.00, 1.02)) and event survival (pulse on hospital arrival) (≤18 minutes: RR = 1.05 (95%CI 1.03, 1.07); 19-22 minutes: RR = 1.03 (95%CI 1.01, 1.05); 23-27 minutes: RR = 1.02 (95%CI 1.00, 1.03). Amiodarone administration within 23 minutes of the emergency call was associated with a higher likelihood of survival to hospital discharge (≤18minutes: RR = 1.17 (95%CI 1.09, 1.24; 19-22 minutes: RR = 1.10 (95%CI 1.04, 1.17).

Conclusion: Amiodarone administered within 23 minutes of the emergency call is associated with improved survival outcomes in shock-refractory VF/pVT, although prospective trials are required to confirm these findings.

Keywords: Amiodarone; Cardiac arrest; Cardiopulmonary resuscitation; Refractory cardiac arrest; Ventricular fibrillation.