Can anyone link me to any legit data regarding AHA stance on post conversion Amio or Lido administration? It is not listed on the current VF/VT arrest algorhythm. I already looked at the 2010 ECC guidelines closely and it was not mentioned in the ROSC section that I could find. Maybe I missed it.  I seem to remember that the 2005 AHA ECC guidelines mentioned that post conversion anti-arrhythmia meds should only be considered if there was a need for it and that data did not support it being given prophylactically. I can’t find any data, either for or against, administration of these meds following a successful VF/VT arrest resuscitation in any current literature.

In addition I am unable to find a copy of  the old 2005 ECC science or guidelines anywhere on the internet.

 

In the 80’s and 90's in San Diego County we used to give post conversion lido and/or bretylium like it was candy.

 

Any help is appreciated....and thank you in advance.

 

mike

 

 

 

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Hi, Mike;

 

Amiodarone is kind of a strange drug: it's the only drug in modern history to have been approved by the US FDA without the huge, high-quality clinical trials that agency ordinarily requires. Furthermore, when it was first put into the ACLS algorithms back in the early 2000's, I recall there being some jokes going around about the quality of evidence at the time and what sorts of favours the makers of Amiodarone must have provided to get it into the ACLS recommendations.

 

The post-arrest care section of the 2010 ECC guidelines states "Patients with cardiac arrest may receive antiarrhythmic drugs such as lidocaine or amiodarone during initial resuscitation. There is no evidence to support or refute continued or prophylactic administration of these medications." Basically, there is no legit data to go on, so ILCOR has left it up to practitioners to make their best guess on whether or not to give antiarrythmics post-ROSC; in EMS that mostly means our medical directors will decide on a protocol based on what they think is best. 

The 2005 ECC guidelines are available in full at http://circ.ahajournals.org/content/112/24_suppl.toc

Also, I'm just barely old enough in this business to remember bretylium being given prehospitally: you might be showing your age there. :) If I'm not mistaken it's not actually manufactured anymore. 

Jason Merrill

http://jkmerrill.ca/

Jason

Thanks for the information and link. I appreciate the time it took to write it.

Those Amio studies in the late 90's (1998 or 99'?) were a little shady my friend.. but it was like; eeeeh what are you gonna do if the medical director wants to use it?? exactly.. nothing especially in California. Resistance is futile.  and the people who made the drug (who also sponsored the studies??) got rich.

and yes they stopped making a couple of drugs during my tenure, one of them Bretylium. ..but hopefully you can stay in the field long enough to have some guy basically call you oldfrom another part of the world.......ha ha. I am a seasoned paramedic bro not old.

Thanks again....... mike

Hey, my service is mostly staffed by 19 & 21 year-old kids, so I have to take my chances to feel like a young turk whenever I can. :)

Jason
(An also-seasoned EMS provider)

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