Cordarone Gives Early Benefit In Out-Of-Hospital Setting

Sanofi/Wyeth-Ayerst's Cordarone (amiodarone), when givenout-of-hospital by paramedics, increases the number of myocardial infarction patients who survive to hospital admission, according to the results of a new study.

ARREST (Amiodarone in out-of-hospital Resuscitation of Refractory Sustained ventricular Tachyarrhythmias) is the first trial to show the effectiveness of an anti-arrhythmic drug in an "on-the-street" cardiac arrest. Amiodarone (300mg) was given to 504 patients who did not respond to three shocks for ventricular fibrillation, and so were candidates for drug treatment (currently lidocaine, procainamide or bretylium - none of which have been conclusively proven to be beneficial in a controlled clinical trial). Amiodarone or placebo was given before any of the other drugs could be administered, in accordance with Advanced Cardiac Life Support guidelines. The primary endpoint was admission alive to hospital. More than two-thirds of the 250,000 Americans who suffer an unexpected MI each year do not survive to reach the emergency room.

Amiodarone achieved a 26% improvement in the primary endpoint, with 49% of this group surviving to reach hospital, compared to 39% of the control group. Furthermore, in a subgroup of patients who respond temporarily to shock treatment and then go into VF again (with a very poor prognosis), there was a 56% improvement (64% versus 41%). The investigators believe that amiodarone should now be included in the ACLS guidelines and be used before lidocaine, procainamide and bretylium.