OBJECTIVE:: To compare the energy required for defibrillation and post shock outcomes following the administration of dronedarone, amiodarone and placebo in a porcine model of cardiac arrest. METHODS:: Forty-two pigs were randomised either amiodarone, dronedarone or control treatments. Following induction of ventricular fibrillation, compressions and ventilations were performed for 3 minutes and treatment was administered over 30 seconds. If defibrillation was unsuccessful, cardiopulmonary resuscitation continued and repeated shocks were administered every 2 minutes with continual haemodynamic monitoring for a total duration of 30 minutes. RESULTS:: The cumulative energy required for defibrillation was 570J ± 422 for dronedarone, 441J ± 365 for amiodarone and 347J ± 281 for control (p=ns). Survival at 30 minutes was 1 (7.1%) for dronedarone compared with 11 (78.6%) for control (p=0.001). Mortality in the dronedarone group was due to refibrillation in 3 (21.4%) cases, atrioventricular (AV) block in 1 (7.1 %) cases and hypotension not due to bradycardia in 9 (64.3%) cases.Two minutes post successful defibrillation, systolic aortic pressure was lower in dronedarone versus control (86.6±26.9 mm Hg versus 110±15.1 mm Hg; p=0.035). CONCLUSIONS:: The administration of dronedarone resulted in a significant reduction in survival and both systolic aortic and coronary perfusion pressure compared with control.
[Show abstract][Hide abstract] ABSTRACT: Aim of this experimental study was to compare haemodynamic effects and outcome with early administration of amiodarone and adrenaline vs. adrenaline alone in pigs with prolonged ventricular fibrillation (VF).
After 8 min of untreated VF arrest, bolus doses were administered of adrenaline (0.02 mg/kg) and either amiodarone (5 mg/kg) or saline (n = 8 per group) after randomisation. Cardiopulmonary resuscitation (CPR) was commenced immediately after drug administration, and defibrillation was attempted 2 min later. CPR was resumed for another 2 min after each defibrillation attempt, and the same dose of adrenaline was given every 4th minute during CPR. Haemodynamic monitoring and mechanical ventilation continued for 6 h after return of spontaneous circulation (ROSC), and the pigs were euthanised at 48 h. Researchers were blinded for drug groups throughout the study.
There was no difference in rates of ROSC and 48-h survival with amiodarone vs. saline (5/8 vs. 7/8 and 0/8 vs. 3/8, respectively). Diastolic aortic pressure and coronary perfusion pressure were significantly lower with amiodarone during CPR and 1 min after ROSC (P < 0.05). The number of electric shocks required for terminating VF, time to ROSC and adrenaline dose were significantly higher with amiodarone (P < 0.01). The incidence of post-resuscitation tachyarrhythmias tended to be higher in the saline group (P = 0.081).
Early administration of amiodarone did not improve ROSC or 48-h survival rates, and was associated with worse haemodynamics in this swine model of cardiac arrest.
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