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Antiarrhythmic drugs in out-of-hospital cardiac arrest: What counts and what doesn’t?

  • Peter J. Kudenchuk
    Correspondence
    Correspondence to: Division of Cardiology/Arrhythmia Services, Box 356422, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-6422, United States.
    Affiliations
    Department of Medicine, Division of Cardiology, University of Washington and King County Emergency Medical Services, Public Health—Seattle and King County, WA, United States
    Search for articles by this author
      Out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) is a catastrophic life event. Its course turns even more ominous when these rhythms prove to be shock-refractory.
      • Berdowski J.
      • ten Haaf M.
      • Tijssen J.G.P.
      • Chapman F.W.
      • Koster R.W.
      Time in recurrent ventricular fibrillation and survival after out of hospital cardiac arrest.
      Antiarrhythmic drugs such as amiodarone or lidocaine in the United States and Europe and nifekalant in Japan, are often deployed in such circumstances in hope of restoring spontaneous circulation (ROSC) and to improve survival. Yet, even after many years of use, doubts linger over the efficacy and effectiveness of these drugs.
      • Olasveengen T.M.
      • Sunde J.
      • Brunborg C.
      • Thowsen J.
      • Steen P.A.
      • Wik L.
      Intravenous drug administration during out of hospital cardiac arrest: a randomized trial.
      • Stiell I.G.
      • Wells G.A.
      • Hebert P.C.
      • Laupacis A.
      • Weitzman B.N.
      Association of drug therapy with survival in cardiac arrest: limited role of advanced cardiac life support drugs.
      Two recent reports in the Journal ask which antiarrhythmic drug (if any) is best for treating shock-refractory OHCA? In doing so, they raise an important additional question, namely what counts and what doesn't when making such an assessment?
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