Learn and Master ACLS/PALS

Hey Jeff!

I know what you mean, I have read the studies that noted that in all cases amiodarone actually DID show an increase in survival to hospital discharge; but characterized the 2-4% (depending on the study) to be “not statistically significant”. But my point in giving the amiodarone was not to use amiodarone as an actual treatment modality as an isolated means to treat the “non sinus rhythm”; but rather just to exert its antiarrythmic effects on a heart that underwent witnessed sudden death (which we later found out to be due to a pulmonary thrombus) has a high likelihood of being in fine VF; and thereby just possibly break the very fine VF that cant be picked up by the monitors into anything that CAN be; be it just breaking it enough to make it more course and thus be able to now follow the VF algorithm because it now allows us to see that its in VF; or break the very fine VF into any other rhythm that can register on the monitor; and likewise we can now treat it by the appropriate algorithm. To have taken precious seconds away from high quality CPR in order to have everyone clear the patient and deliver the shocks, when the rhythm on the monitor is asystole, would have opened us up to legal malpractice issues for those precious seconds lost to high quality CPR without a guarantee that the heart was in VF. Whereas giving the only recommended first choice antiarrythmic (amiodarone) took absolutely not one second away from nonstop high quality CPR; and may have allowed the highly likely VF to register on the monitor and now allow us to follow the VF algorithm and legally be right to take those valuable seconds from CPR to give the shocks. By administering the amiodarone, it gave a harmless additional option to show proof on the monitor of the undeniably high possibility that this patient was in very fine VF, and thus allow us to focus on interventions that have the ability to improve survival such as high quality chest compressions and defibrillation. Do you now see why the cardiology expert that was consulted agreed with my decision to administer amiodarone “while not part of the asystole algorithm, was not only an appropriate intervention; but also an indicated one”? And, based on the science, do you agree?

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(I also read a recent study that concluded that Amiodarone and lidocaine are associated with slightly better survival outcomes compared with placebo in patients with non-shockable-turned-shockable out-of-hospital cardiac arrest (OHCA), according to a randomized double-blind study published in Circulation. In all, 16 (4.1%) amiodarone, 11 (3.1%) lidocaine and 6 (1.9%) placebo-treated patients survived to hospital discharge (p=0.24). Over one-half of these survivors were functionally independent or required minimal assistance. Drug-related adverse effects were infrequent. They wrote “Conclusions—Outcome from non-shockable-turned-shockable OHCA is poor, but not invariably fatal. Though not statistically significant, point estimates for survival were greater after amiodarone than lidocaine or placebo, without increased risk of adverse effects or disability, and consistent with previously observed favorable trends from treatment of initial shock-refractory VF/VT with these drugs. In addition, “improving absolute survival by merely 4% in this patient population means more than 2000 additional lives might be saved each year in North America from non-shockable-turned-shockable OHCA alone. So while some may argue that 4% may not be largely considered “statistically significant”, the families of the 2000 additional lives saved by the administration of amiodarone, without increased risk of adverse effects or disability from amiodarone, would argue it to be incredibly significant.”)

….But I would like to know if, in your expert opinion, agree with my administration of amiodarone; “while not part of the asystole algorithm, was not only an appropriate intervention; but also an indicated one” based on the science we now know about witnessed sudden deaths.

Thanks so much for your thoughts and expert opinion