Table 1 Study characteristics
From: Antiarrhythmia drugs for cardiac arrest: a systemic review and meta-analysis
Study design | Setting and sample size | Inclusion of participants | Intervention | Control | Reported outcomes | |
|---|---|---|---|---|---|---|
Kudenchuk et al.[11] | Randomized, double-blind, placebo-controlled study | Conducted in urban and suburban emergency medical service (EMS) systems in US, CPR was performed following the treatment protocols written in accordance with American Heart Association guidelines for advanced cardiac life support (ACLS) in 1982; 504 participants were enrolled | Adults with nontraumatic out-of-hospital cardiac arrest were eligible if ventricular fibrillation or pulseless ventricular tachycardia (on initial presentation or any time in the course of the resuscitation attempt) was present after three or more precordial shocks | 300 mg of amiodarone diluted with dextrose, given intravenously | The diluent, polysorbate 80 as placebo | Survival to hospital intensive care unit admission; survival to hospital discharge |
Skrifvars et al. [12] | Retrospective designed study | Conducted by Helsinki EMS systems; CPR was performed according to 2000 guidelines; 180 patients were enrolled | Adult OHCA patients with VF/pulseless VT resistant to three shocks | A bolus of 300 mg amiodarone after three ineffective shocks, an additional 150-mg dose might be administered | No amiodarone was administered | ROSC; survival to hospital admission; survival to hospital discharge |
Fatovich et al. [15] | Double-blind, randomized controlled study | Undertaken at the ED of Royal Perth Hospital which served a population of 400,000 residents in urban setting; CPR was performed in accordance with the guidelines for clinical trials published by the Australian National Health and Medical Research Council; 67 patients were enrolled | All victims of OHCA receiving CPR, brought to the ED by the EMS system were eligible. Patients were excluded if they were already dead, not receiving CPR, already successfully resuscitated, or if the cardiac arrest was due to a noncardiac etiology | 5 g MgSO4 (20 M in 10 ml), given as a bolus | 10 ml 0.9% normal saline, given as a bolus | ROSC; 24-hour survival; survival to hospital discharge |
Thel et al. [16] | Double-blind, randomized controlled study | Conducted by the Duke Hospital code team, CPR was performed according to the American Heart Association guidelines for ACLS; 152 participants were enrolled | All hospital inpatients in the intensive-care units and general wards who were at least 18 years old and treated for cardiac arrest by the Duke Hospital code team were eligible | 2 g bolus of magnesium sulfate followed by an infusion of 8 g over 24-hour period | Matching placebo | ROSC; 24-hour survival; survival to hospital discharge; neurologic outcomes at hospital discharge (assessed by Glasgow Coma Scale score) |
Allegra et al. [14] | Double-blind, randomized controlled study | Multicenter prehospital study clinical trial conducted in NJ, USA; standard ACLS algorithm was followed; 109 patients were enrolled | All patients with nontraumatic cardiac arrest who were 18 years of age or older and had VF refractory to three electroshocks | 2 g magnesium sulfate | Equal volume of saline as placebo | ROSC; 24-hour survival; survival to hospital discharge |
Hassan et al.[13] | Double-blind, randomized controlled study | Undertaken by the Leicestershire Ambulance and Paramedic Service which provided prehospital care to approximately 900,000 people in urban settings; CPR was performed according to ERC guidelines in 1992; 105 patients were enrolled | All adult patients (older than 18 years) with prehospital CA treated by EMS or in CA on arrival in the emergency department. The patient had either VF resistant to three shocks or a second episode of VF during a resuscitation cycle. CA patients related to trauma, hanging, or drowning were excluded | Magnesium sulfate (2 g or 8 mM) repeated with a further 2 g if the patient remained in VF after six shocks | Matched normal saline placebo | ROSC; 24-hour survival; survival to hospital discharge; Neurologic outcomes at hospital discharge (assessed by Glasgow Coma Scale score) |
Harrision [17] | Retrospective design | Undertaken by EMS in urban and rural counties; 116 patients were enrolled | Adult patients with shock-resistant VF/VT | 100-mg lidocaine bolus | No lidocaine given | Survival to admission; survival to discharge |
Herlitz et al.[18] | Retrospective design | Conducted by two city hospitals in urban settings; 290 patients were enrolled | Adult cardiac-caused OHCA patients with VF/VT resistant to three shocks | 50 mg lidocaine was given intravenously (could be repeated up to 200 mg) | No lidocaine given | ROSC; survival to coronary care unit admission; survival to discharge |
Dorian et al. [19] | Randomized, double-blind, placebo-controlled study | The study was conducted under the auspices of, a multitiered out-of-hospital emergency-response system in Toronto; treatment protocols were in accordance with the American Heart Association guidelines for advanced cardiac life support; 347 participants were enrolled | Adult patients with nontraumatic out-of-hospital VF/other cardiac rhythms that converted to VF, VF was resistant to three shocks from an external defibrillator, at least one dose of intravenous epinephrine, and a fourth defibrillator shock | Amiodarone(5 mg/kg of estimated body weight diluted with dextrose), infused rapidly into a peripheral vein | Lidocaine (1.5 mg/kg at a concentration of 10 mg/ml), infused rapidly into a peripheral vein | Survival to hospital intensive care unit admission; survival to hospital discharge |
Rea et al.[20] | Multicenter retrospective cohort study | Undertaken in three academic medical centers in the United States; CPR treatments and drug doses were according to 2000 AHA guidelines; 118 patients were enrolled | Patients experienced in-hospital cardiac arrest secondary to pulseless VT/VF were included. Pregnant women, prisoners, and patients younger than 18 years were excluded | Amiodarone administrated as recommended by the 2000 AHA guidelines | Lidocaine administered as recommended by the 2000 AHA guidelines | Survival to 24 hours; survival to hospital discharge |
Amino et al. [21] | Retrospective observational study | Conducted by EMS system of Tokai University. The CPR protocol was adapted from ACLS algorithm recommended by AHA; 30 patients were enrolled | Adult out-of-hospital cardiac arrest patients with first defibrillation failure or VF recurrence were included | Nifekalant | Amiodarone | ROSC; survival to admission; survival to hospital discharge |
Igarashi et al. [24] | Retrospective observational design | Conducted by Toho Omori University Hospital; 22 patients were enrolled | Adult out-of-hospital cardiac arrest patients with VF and unsuccessful defibrillation attempts by paramedics | Nifekalant(0.2-0.4 ml/kg) | Lidocaine(1–2 mg/kg) | ROSC; survival to discharge |
Tahara et al. [23] | Retrospective, historic controlled design | Undertaken in urban settings in Yokohama, Japan; CPR treatments were according to 2000 AHA guidelines; 120 patients were enrolled | Patients who had out-of-hospital VF and were transferred to the university hospital, VF persisted after three shocks and a dose of epinephrine and another shock | Intravenous nifekalant (0.3 mg/kg) | Intravenous lidocaine (1.5 mg/kg) | Survival to admission; survival to hospital discharge |
Shiga et al. [22] | Prospective observational study | Conducted in the cardiology departments of 10 hospitals in urban settings | Adult patients with VF when admitted to hospital | Nifekalant | Amiodarone | ROSC; short-term survival; survival to discharge |
Nowak et al. [26] | Double-blinded, randomized | CPR treatments were consistent with American Heart Association protocols | OHCA patients | 10 mg/kg of bretylium | Placebo | Survival to emergency department leaving |
Olson et al. [25] | Randomized study | Conducted with the Milwaukee County Paramedic system | OHCA patients with refractory VF | 5-10 mg/kg bretylium | 1 mg/kg lidocaine | Survival to admission; survival to discharge |
Kovoor et al. [27] | Randomized, double-blinded study | Conducted with the Ambulance Service of New South Wales | OHCA due to refractory VF | 100 mg of sotalol | 100 mg of lidocaine | Survival to admission; survival to discharge |