Amiodarone and rural emergency medical services cardiac arrest patients: a cost analysis.
OBJECTIVE
Recent American Heart Association guidelines suggest amiodarone as an antiarrhythmic in refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). The authors sought to assess the impact of amiodarone use on outcomes and cost associated with this practice in a rural emergency medical services (EMS) state.


METHODS
Statewide EMS records were reviewed for the calendar year 1999. Data reviewed included prehospital diagnosis, medications given by prehospital providers to patients with cardiac arrest, and procedures performed, including cardiopulmonary resuscitation (CPR) and defibrillation. Cost-benefit analysis assumed the cost of amiodarone treatment to be $137.65 per patient encounter. Absolute risk reduction (ARR) and number needed to treat (NNT) analysis utilized resuscitation rates published in the ARREST and ALIVE trials.


RESULTS
During the study period, EMS providers diagnosed 2,189 patients as having cardiac arrest. Five hundred thirty-five (24.4%) cardiac arrest patients were defibrillated. One hundred sixty patients (7.3%), including 15 who did not receive defibrillation, were given lidocaine during resuscitation efforts. The annual cost increase from current practice for a statewide amiodarone VF/VT protocol was $21,822.40 (10,572.87%). The initial cost to stock EMS vehicles for this protocol would be $50,115.52. The cost-benefit analysis yielded a potential for one additional patient survival to hospital discharge in Maine per 3.125 years of system-wide practice at a cost of $68,840.00.


CONCLUSIONS
Based on current data, instituting amiodarone treatment for refractory VF and pulseless VT in a rural EMS setting requires the investment of substantial resources, relative to current treatment strategies, for any potential survival benefit.
Department of Emergency Medicine, Maine Medical Center, Portland 04102, USA.
Teresa E
TE
Pazdral
John H
JH
Burton
Tania D
TD
Strout
Jay R
JR
Bradshaw
D000328:Adult; D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage*; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000191:economics* / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008020:Life Support Care / Q000191:economics / Q000379:methods; D008281:Maine; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012424:Rural Population; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000401:mortality*
D000638:Amiodarone