Amiodrone's use in cardiac arrest

  Sirs;
  I am a paramedic involved in researching information on a new therapy we are looking at putting on our ambulances. I would greatly appreciate your opinions and input as well as direction in finding any studies that have been done.
  It has been brought to our attention that studies have been done with Cordarone for cardiac arrest with sustained V-fib refractory to Lidocaine. We are considering adding this drug to our current protocol following exhaustion of first line therapies and before Bretylium. We have been told that administration of this drug in the manner listed above greatly improved the chances of a save. Also greatly improving the chances of that save leaving the hospital alive. This is a subject that we as pre-hospital providers  take very much to heart. We live to make a save, but a save is not enough. We want to see that person walk away from the ICU.
  Please share with me any info you might have about this "new miracle" drug. Any opinions,studies or personal experiences would be appreciated.Thank you for your time.
  Beth Purcell EMT/P TX

[CCF Cardio MD - MTR]

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Dear Beth, thank you for your question.  You should be congratulated for your dedication to treating patients with out-of-hospital cardiac arrest who you know have a very poor prognosis.  Amiodarone is now available in the U.S. in an intravenous form.  The company which makes amiodarone has marketed it as the panacea of anti-arrhythmic medications.  However, there have been no randomized, double-blind clinical trials comparing amiodarone to lidocaine for ventricular arrhythmias.  The evidence that does exist is anecdotal and is unfortunately touted as the "truth."   Amiodarone is a very expensive medication, so we should be sure that it is properly evaluated before widespread use is advocated.  For the present time, we recommend that traditional ACLS protocols be used for ventricular arrhythmias that cause cardiac arrest (lidocaine - bretylium - procainamide).  Amiodarone can be used "down the line" in these protocols, but is not presently recommended as first line therapy.  We hope that good quality clinical studies will soon be available that can clear up some of the present confusion.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
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