Abstract 273: A Blinded Evaluation of Combination Drug Therapy for Prolonged Ventricular Fibrillation Cardiac Arrest

• Published in: Circulation (New York, N.Y.) Vol. 126; no. suppl_21
• Main Authors: Mader, Timothy J, Coute, Ryan A, Millay, Scot A, Jensen, Lennard C, Misiaszek, Richard, Kellogg, Adam R
• Format: Journal Article
• Language: English
• Published: 20-11-2012
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.126.suppl_21.A273

Abstract only
Background
: There are many examples of medical disease treatment innovating from single agent, failure-based, serial medication delivery to first-line combination drug therapy. Could the same approach improve outcomes in the metabolic phase of VF?
Objective:
Using a swine model of prolonged VF, we compared ROSC and 20-minute survival in animals treated with single agents given in series to animals provided first-line combination drug therapy.
Methods
: The study was IACUC approved. Eighty swine (25-30 kg) were surgically instrumented under anesthesia, and VF was electrically induced. After 12 minutes of untreated VF, animals were 2:1 block randomized to 1 of 2 resuscitation schemes. SERIES (n=53) received: epinephrine (0.01 mg/kg [SDE]); vasopressin (0.57 mg/kg); amiodarone (4.3 mg/kg) and SDE; sodium bicarbonate (1 mEq/kg) and SDE - each delivery punctuated by a RS after 3 minutes of CPR. If ROSC occurred after any RS, supportive care was provided and subsequent medications were not given. COCKTAIL (n=27) received all drugs together (with metoprolol [0.2 mg/kg]), followed by CPR and RS1. A SDE followed each failed RS. All drugs were given IV with a flush. CPR and RS attempts were standardized. Resuscitation continued until ROSC was achieved or 20 minutes elapsed without ROSC. Group comparisons were assessed using descriptive statistics. Proportions with 95%CI were calculated for VF termination, ROSC, and survival.
Results
: At baseline, the two groups were similar. The figure summarizes our findings. SERIES outcomes mirrored historical controls.
Conclusion
: In this swine model of prolonged OHCA, short-term outcomes were adversely affected by this drug/dosage combination.