Report from J-PULSE multicenter registry of patients with shock-resistant out-of-hospital cardiac arrest treated with nifekalant hydrochloride.
BACKGROUND
Nifekalant hydrochloride (NIF) is an intravenous class-III antiarrhythmic agent that purely blocks the K(+)-channel without inhibiting β-adrenergic receptors. The present study was designed to investigate the feasibility of NIF as a life-saving therapy for out-of-hospital ventricular fibrillation (VF).


RESULTS
The Japanese Population-based Utstein-style study with basic and advanced Life Support Education study was a multi-center registry study with 4 participating institutes located at the northern urban area of Osaka, Japan. Eligible patients were those treated with NIF because of out-of-hospital VF refractory to 3 or more precordial shocks and intravenous epinephrine. Between February 2006 and February 2007, 17 patients were enrolled for the study. The time from a call for emergency medical service to the first shock was 12(6-26)min. The time from the first shock to the NIF administration was 25.5(9-264)min and the usage dose of NIF was 25(15-210)mg. When excluding 3 patients in whom percutaneous extracorporeal membrane oxygenation was applied before NIF administration, the rate of return of spontaneous circulation was 86% and the rate of admission alive to the hospital was 79%. One patient developed torsade de pointes.


CONCLUSIONS
Intravenous administration of NIF seems to be feasible as a potential therapy for advanced cardiac life-support in patients with out-of-hospital VF, and therefore further study is warranted.
Yasuda
Satoshi
S
National Cerebral and Cardiovascular Center, Saiseikai Senri Hospital, Senri Critical Care Medical Center, Suita.
Sawano
Hirotaka
H
Hazui
Hiroshi
H
Ukai
Isao
I
Yokoyama
Hiroyuki
H
Ohashi
Junko
J
Sase
Kazuhiro
K
Kada
Akiko
A
Nonogi
Hiroshi
H
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D047548:Defibrillators; D004554:Electric Countershock / Q000295:instrumentation; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010343:Patient Admission; D010865:Pilot Projects; D011446:Prospective Studies; D011744:Pyrimidinones / Q000008:administration & dosage*; D012042:Registries; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016171:Torsades de Pointes / Q000139:chemically induced; D017211:Treatment Failure; D014693:Ventricular Fibrillation / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*
D000889:Anti-Arrhythmia Agents; D011744:Pyrimidinones; C076259:nifekalant