Researchers determine best possible drug option for cardiac arrest

TORONTO -- Data published in the New England Journal of Medicine by St. Michael's Hospital/University of Toronto researchers demonstrates that the anti-arrhythmic agent IV amiodarone is almost twice as effective as lidocaine in keeping patients alive to hospital. As a result of this study, amiodarone is carried by Toronto ambulances responding to cardiac arrests and there are major implications for the recommended standard of treatment of cardiac arrest by paramedics and hospitals across North America.

Heart disease is the number one killer in North America. More than 25,000 Canadians and over 250,000 Americans suffer out-of-hospital cardiac arrest every year. Unfortunately, fewer than 10 per cent of these patients survive. Many of these cardiac arrests are caused by a potentially lethal heart rhythm disturbance called ventricular fibrillation, or VF. Patients suffering from VF will die unless they receive CPR and an electrical shock (defibrillation) within five to seven minutes to restore normal heart beating. Early CPR is essential, followed rapidly by defibrillation. If defibrillation does not work immediately, the next step is to use an anti-arrhythmic drug, followed by additional defibrillations.

Prior to this study, commonly-used anti-arrhythmic drugs had not been scientifically compared to determine which was most effective. Traditionally, lidocaine has been the drug used in these cardiac arrest situations. In 2000, the American Heart Association Advanced Life Support guidelines recommended a promising drug called amiodarone as an alternative. However, considerable controversy remained as to which drug was preferable.

The ALIVE (Amiodarone versus Lidocaine In pre-hospital Ventricular fibrillation Evaluation) trial, the first such trial to undertake a head-to-head comparison of anti-arrhythmic drugs, studied the effectiveness of lidocaine versus amiodarone. The trial followed 347 randomized patients who had suffered cardiac arres

Contact: Tracey MacIsaac
University of Toronto

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