Can nifekalant hydrochloride be used as a first-line drug for cardiopulmonary arrest (CPA)? : comparative study of out-of-hospital CPA with acidosis and in-hospital CPA without acidosis.
BACKGROUND
Early defibrillation of ventricular tachycardia and fibrillation (VT/VF) is an urgent and most important method of resuscitation for survival in cardiopulmonary arrest (CPA). We have previously reported that nifekalant (NIF), a specific I(Kr) blocker developed in Japan, is effective for lidocaine (LID) resistant VT/VF in out-of-hospital CPA (OHCPA). However, little is known about the differences in the effect of NIF on OHCPA with acidosis and in-hospital CPA (IHCPA) without acidosis.


RESULTS
The present study enrolled 91 cases of DC shock resistant VT/VF among 892 cases of CPA that occurred between June 2000 and May 2003. NIF was used (0.15-0.3 mg/kg) after LID according to the cardiopulmonary resuscitation (CPR) algorithm of Tokai University. The defibrillation rate was higher in the NIF group for both OHCPA and IHCPA than for LID alone, and the VT/VF rate reduction effect could be maintained even with acidosis. However, sinus bradycardia in OHCPA, and torsades de pointes in IHCPA were occasionally observed. These differences in adverse effects might be related to the amount of epinephrine, serum potassium levels, serum pH, and interaction with LID.


CONCLUSIONS
NIF had a favorable defibrillating effect in both CPA groups, and it shows promise of becoming a first-line drug for CPR.
Yoshioka
Koichiro
K
Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan. ko1@is.icc.u-tokai.ac.jp
Amino
Mari
M
Morita
Seiji
S
Nakagawa
Yoshihide
Y
Usui
Kazutane
K
Sugimoto
Atsuhiko
A
Matsuzaki
Atsushi
A
Deguchi
Yoshiaki
Y
Yamamoto
Isotoshi
I
Inokuchi
Sadaki
S
Ikari
Yuji
Y
Kodama
Itsuo
I
Tanabe
Teruhisa
T
D000138:Acidosis / Q000150:complications* / Q000188:drug therapy; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D004554:Electric Countershock; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011188:Potassium / Q000097:blood; D011744:Pyrimidinones / Q000627:therapeutic use*; D012151:Resuscitation; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000628:therapy
D000889:Anti-Arrhythmia Agents; D011744:Pyrimidinones; C076259:nifekalant; D011188:Potassium; D004837:Epinephrine