Comparison of nifekalant and lidocaine for the treatment of shock-refractory ventricular fibrillation.
BACKGROUND
Although nifekalant is a class III antiarrhythmic agent without negative inotropic activity, its effect in patients with shock-refractory ventricular fibrillation remains unclear.


RESULTS
Patients who had an out-of-hospital cardiac arrest with ventricular fibrillation that persisted after 3 shocks from an external defibrillator, intravenous epinephrine, and another shock were retrospectively studied. The patients received lidocaine from January 1997 through June 2001 and nifekalant from July 2001 through December 2004. Short-term survival rates (survival to hospital admission and 24-h survival) were compared between the groups. The study group comprised 120 patients (mean age: 62+/-16 years): 55 received nifekalant and 65 received lidocaine. Age, sex, history of ischemic heart disease, whether arrest was witnessed or not and time to arrival at the hospital did not differ significantly between the groups. As compared with lidocaine, nifekalant was associated with significantly higher rates of survival to hospital admission (67% vs 37%, p<0.001) and 24-h survival (53% vs 31%, p=0.01). Multivariate analysis showed that treatment with nifekalant and early initiation of cardiopulmonary resuscitation were independent predictors of 24-h survival.


CONCLUSIONS
As compared with lidocaine, nifekalant may improve short-term survival in patients with out-of-hospital cardiac arrest due to shock-refractory ventricular fibrillation.
Division of Critical Care and Emergency Medicine, Yokohama City University Medical Center, Japan.
Yoshio
Y
Tahara
Kazuo
K
Kimura
Masami
M
Kosuge
Toshiaki
T
Ebina
Shinichi
S
Sumita
Kiyoshi
K
Hibi
Hideshi
H
Toyama
Takayuki
T
Kosuge
Yoshihiro
Y
Moriwaki
Noriyuki
N
Suzuki
Mitsugi
M
Sugiyama
Satoshi
S
Umemura
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D016887:Cardiopulmonary Resuscitation; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011744:Pyrimidinones / Q000627:therapeutic use*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality
D000889:Anti-Arrhythmia Agents; D011744:Pyrimidinones; C076259:nifekalant; D008012:Lidocaine; D004837:Epinephrine