title: Administration of amiodarone during resuscitation is associated with higher tumor necrosis factor-α levels in the early postarrest period in the swine model of ischemic ventricular fibrillation.
abstract: To compare the early postarrest inflammatory cytokine response between animals administered amiodarone (AMIO) and lidocaine (LIDO) intra-arrest during resuscitation from ventricular fibrillation (VF). Domestic swine (n=32) were placed under general anesthesia and instrumented before spontaneous VF was induced by balloon occlusion of the left anterior descending coronary artery. After 7 min of VF, standard ACLS resuscitation was performed and animals were randomized to either bolus AMIO (5 mg/kg, n=13) or LIDO (1 mg/kg, n=14) for recurrent or refractory VF. A non-antiarrhythmic (n=5) was also used for comparison. Following return of spontaneous circulation (ROSC), tumor necrosis factor (TNF)-α levels were drawn at 30 and 60 min. Groups were comparable with respect to prearrest hemodynamics and resuscitation variables. In the postarrest period, the LIDO and non-antiarrhythmic group demonstrated virtually identical TNF-α response trajectories. However, TNF-α levels were significantly higher in AMIO- than LIDO-treated animals at 30 min (geometric mean 539 versus 240 pg/mL, 2.2-fold higher, 95% confidence interval [CI] 1.3-3.8-fold higher, P=0.003) and at 60 min (geometric mean 570 versus 204 pg/mL, 2.8-fold higher, 95% CI 1.1-7.0-fold higher, P=0.03). Significant differences in the postarrest TNF-α levels were observed between animals treated with AMIO as compared to those treated with LIDO. Improved rates of ROSC seen with AMIO may come at the expense of a heightened proinflammatory state in the postcardiac arrest period.
authors: Division of Emergency Medicine, Department of Surgery, The University of Utah, Salt Lake City, Utah 84132, USA. scott.youngquist@utah.edu
authors: Scott T
authors: ST
authors: Youngquist
authors: James T
authors: JT
authors: Niemann
authors: Atman P
authors: AP
authors: Shah
authors: Joseph L
authors: JL
authors: Thomas
authors: John P
authors: JP
authors: Rosborough
mesh_terms: D000638:Amiodarone / Q000494:pharmacology*; D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003331:Coronary Vessels / Q000187:drug effects / Q000378:metabolism; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000187:drug effects; D007249:Inflammation / Q000188:drug therapy / Q000378:metabolism; D008012:Lidocaine / Q000494:pharmacology; D008297:Male; D017202:Myocardial Ischemia / Q000378:metabolism / Q000503:physiopathology; D019105:Random Amplified Polymorphic DNA Technique; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology
chemical_list: D000889:Anti-Arrhythmia Agents; D014409:Tumor Necrosis Factor-alpha; D008012:Lidocaine; D000638:Amiodarone
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