title: Antipsychotic drugs are associated with pulseless electrical activity: the Oregon Sudden Unexpected Death Study.
abstract: BACKGROUND
  There has been a paradigm shift in the manifestation of sudden cardiac arrest (SCA), with steadily decreasing rates of ventricular fibrillation/tachycardia (VF/VT) and a significant increase in the proportion of pulseless electrical activity (PEA) and asystole.
  
  
  OBJECTIVE
  Since PEA is marked by failure of myocardial contractility, we evaluated the potential role of drugs that affect cardiac contractility in the pathophysiology of human PEA.
  
  
  METHODS
  Subjects with out-of-hospital SCA (aged≥18 years) who underwent attempted resuscitation were evaluated in the ongoing Oregon Sudden Unexpected Death Study (2002-2009). Specific classes of medications with either negative or positive cardiac inotropic effects were evaluated for association with occurrence of PEA vs VF/VT by using Pearson χ(2) tests and logistic regression.
  
  
  RESULTS
  PEA cases (n = 309) were older than VF/VT cases (n = 509; 68±14 years vs 64±15 years; P<.0001) and were more likely to be women (39% vs 25%; P<.0001). In a logistic regression model adjusting for age, sex, comorbidities, disease burden, and resuscitation variables, antipsychotic drugs (odds ratio 2.40; 95% confidence interval 1.26-4.53) were significant predictors of PEA vs VF/VT. Conversely, use of digoxin was associated with the occurrence of VF/VT (P<.0001).
  
  
  CONCLUSIONS
  When drugs modifying myocardial contractility were evaluated in a comprehensive analysis of patients who suffered SCA, use of antipsychotic agents was a significant and independent predictor of manifestation with PEA.
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Teodorescu
authors.forename: Kyndaron
authors.initials: K
authors.lastname: Reinier
authors.forename: Audrey
authors.initials: A
authors.lastname: Uy-Evanado
authors.forename: Harpriya
authors.initials: H
authors.lastname: Chugh
authors.forename: Karen
authors.initials: K
authors.lastname: Gunson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D015984:Causality; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009922:Oregon; D058687:Out-of-Hospital Cardiac Arrest / Q000139:chemically induced* / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D014693:Ventricular Fibrillation / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality / Q000628:therapy
chemical_list: D014150:Antipsychotic Agents