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Increasing amiodarone use in cardiopulmonary resuscitation: An analysis of the National Registry of Cardiopulmonary Resuscitation

October, Tessie W. MD; Schleien, Charles L. MD; Berg, Robert A. MD; Nadkarni, Vinay M. MD; Morris, Marilyn C. MD, MPH for the National Registry of Cardiopulmonary Resuscitation Investigators

doi: 10.1097/01.CCM.0000295592.97331.5A
Clinical Investigations
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Objective: To examine practice patterns of amiodarone use during in-hospital cardiac arrest. This study addresses the changing pattern of amiodarone use over time, following the publication of landmark studies and the inclusion of amiodarone in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Furthermore, this study examines the impact of hospital and patient specific factors on the use of amiodarone.

Design: Retrospective cohort study, using the National Registry for Cardiopulmonary Resuscitation, an international registry of in-hospital resuscitation events.

Patients: All patients with an in-hospital ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) event reported to the national registry from January 1, 2000, to July 31, 2005.

Measurements and Main Results: During the study period, 14,854 of 29,552 (50%) adults (>18 yrs old) with VF/pVT received an antiarrhythmic drug; 8,883 (60%) of these patients received amiodarone. In adults, amiodarone use for VF/pVT increased from 25% in 2000 to 72% in 2005 (p < .0001). Among children, 270 of 553 (49%) VF/pVT episodes were treated with an antiarrhythmic drug; 108 (40%) of these patients received amiodarone. Adults in institutions with larger intensive care units (>50 beds) were more likely than those in institutions with smaller intensive care units (≤50 beds) to receive amiodarone; the association persisted in multivariable analysis (odds ratio [OR] = 1.825; 95% confidence interval [CI], 1.694–1.966). Thirty five percent of adults with VF/pVT who received amiodarone also received lidocaine, while 67% of children who received amiodarone also received lidocaine (p < .001). It is not possible to determine from the database the order in which medications were administered.

Conclusions: There has been a significant increase in amiodarone use for VF/pVT events over the past 5 yrs. The frequency of amiodarone use in adults correlated positively with the number of intensive care beds. These results suggest that emerging data and national guidelines affect resuscitation practice patterns.

From the College of Physicians and Surgeons, Columbia University, New York, NY (TWO, CLS, MCM); College of Medicine, University of Arizona, Tucson, AZ (RAB); and Children's Hospital of Philadelphia, PA (VMN).

The American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators includes the authors and E. Allen, R. S. Braithwaite, S. Carey, Robert Clark, Heidi Dalton, B. Eigel, E. Hunt, W. Kaye, G. Luke Larkin, Peter Laussen, M. E. Mancini, Frank Moler, G. Nichol, Joseph P. Ornato, Christopher Parshuram, Mimi Peberdy, J. Potts, M. Smyth, T. Lane-Truitt, and Arno Zaritsky.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: to2122@columbia.edu

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins