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Antiarrhythmics in Cardiac Arrest: A Systematic Review and Meta-Analysis
Amelia Chowdhury1, Brian Fernandes2, Thomas M Melhuish3
1St Vincent's Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Heart, Lung & Circulation
|October 10, 2017
Summary
This review found no conclusive evidence that antiarrhythmic drugs improve survival or neurological outcomes during cardiopulmonary resuscitation (CPR). Further research is needed to clarify the role of these agents in advanced life support.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Antiarrhythmic drugs are widely used in cardiopulmonary resuscitation (CPR), but their definitive benefit and optimal choice in advanced life support remain debated.
- Current guidelines acknowledge their role, yet robust evidence supporting their efficacy is lacking.
Purpose of the Study:
- To conduct a comprehensive systematic review and meta-analysis of existing literature.
- To evaluate the efficacy of various antiarrhythmic agents in adult cardiac arrest patients undergoing advanced life support.
Main Methods:
- Systematic literature search across multiple databases (CINAHL, SCOPUS, PubMed, Web of Science, Medline, Cochrane).
- Inclusion of studies comparing antiarrhythmics against placebo, control, or other antiarrhythmics in adult cardiac arrests.
- Assessment of outcomes including return of spontaneous circulation (ROSC), survival rates, and neurological function, using the Mantel-Haenszel random effects model and Cochrane's risk of bias tool.
Main Results:
- Analysis of 30 studies involving 39,914 patients identified eight antiarrhythmic agents.
- Amiodarone and lidocaine showed no significant benefit over placebo or each other for any outcome.
- Limited evidence suggested potential benefits for esmolol and bretylium in specific outcomes, and nifekalant showed a significant survival benefit over lidocaine to admission.
Conclusions:
- Current evidence does not conclusively demonstrate that antiarrhythmic agents improve ROSC, survival, or neurological outcomes in CPR.
- The review highlights a lack of definitive data supporting the routine use of most antiarrhythmics in advanced life support.
- Further research is recommended to clarify the utility and potential side effects of antiarrhythmic agents in CPR guidelines.
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