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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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iSepsis – Understanding Lactate

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miércoles, 5 de octubre de 2016

Anti-Arrhythmics

Taming The SRU - October 04, 2016 - By Teuber J, Shah A, Hill J
Ortiz M et al. Randomized Comparison of Intravenous Procainamide vs. Intravenous Amiodarone for the Acute Treatment of Tolerated Wide QRS Tachycardia: the PROCAMIO Study. Eur Heart J 2016. PMID: 27354046
...While it is a bit of a stretch to conclude procainamide should be first line instead, it may be worthy of consideration as another tool in your armamentarium of antiarrhythmics. Still, all of these patients are quick to decompensate, so you will want to prepare for the worst- always keep the defib pads on the patient and have a backup plan in place!

Kudenchuk, P. J., Brown, S. P., Daya, M., Rea, T., Nichol, G., Morrison, L. J., et al. (2016). Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. New England Journal of Medicine, 374(18), 1711–1722. http://doi.org/10.1056/NEJMoa1514204
...Strictly speaking, amiodarone and lidocaine don’t improve survival to discharge from the hospital but do result in better survival to hospital admission. This isn’t the final word on this subject. Because they improve survival to hospital admission, as in-hospital patient treatments continue to improve, anti-arrhythmic medications may be found, in the future, to improve survival to discharge.
Ageliki Laina et al. Amiodarone and cardiac arrest: Systematic Review and meta-analysis. International Journal of Cardiology. 2016. PMID: 27434349
  1. The researchers did so a sub-analysis that only included randomized control studies that did show a statistically significant improvement in ROSC prior to hospital admission.
  2. Amiodarone was shown to improve the incidence of survival to hospital admission compared to other interventions (placebo, lidocaine, nifekalant)
  3. There was no improvement in survival noted at 24 hour post ROSC in patients that received amiodarone. 
  4. When the data was analyzed, there appeared to be no improvement in survival to hospital discharge in patients that received amiodarone.
  5. Amiodarone was not associated with improved neurologic status at the time of hospital discharge.