Yu Huang, Qing He, Min Yang, Lei Zhan Critical Care 2013, 17:R173 (12 August 2013)

Introduction:  Anti-arrhythmia agents have been used in the treatment of cardiac arrest, and we aimed to review the relevant clinical controlled trials in order to assess the effects of anti-arrhythmics during cardiopulmonary resuscitation.

Methods:  We searched databases including Cochrane Central Register of Controlled trials; MEDLINE and EMBASE. Clinical controlled trials that addressed the effects of anti-arrhythmics (including amiodarone, lidocaine, magnesium and other new potassium channel blockers) on the outcomes of cardiac arrest were included. Data was collected independently by two authors. The risk ratio of each outcome was collected, and meta-analysis would be used for data synthesis if appropriate. Heterogeneity was assessed with the chi-squared test and the I2 test.

Results: Ten randomized controlled trials and seven observational trials were identified. Amiodarone (RR:0.82; 95%:0.54, 1.24), lidocaine (RR:2.26; 95%:0.93, 5.52), magnesium (RR:0.82; 95%:0.54, 1.24) and nifekalant were not shown to improve the survival to hospital discharge compared to placebo, but amiodarone, lidocaine and nifekalant were shown to be beneficial to initial resuscitation, assessed by the rate of return of spontaneous circulation and survival to hospital admission, with amiodarone being superior to lidocaine (RR:1.28; 95%:0.57, 2.86) and nifekalant (RR:0.50; 95%:0.19, 1.31). Bretylium and sotalol were not shown to be beneficial.

Conclusions: Our review suggested that when administered during resuscitation, anti-arrhythmia agents might not improve the survival to hospital discharge, but they might be beneficial to initial resuscitation. This is consistent with the AHA 2010 guidelines for resuscitation and cardiovascular emergency, but more studies which have good methodological quality and large numbers of patients are still needed to make further assessment.

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