title: Comparison of nifekalant and amiodarone for resuscitation of out-of-hospital cardiopulmonary arrest resulting from shock-resistant ventricular fibrillation.
abstract: OBJECTIVE
  Nifekalant is a pure potassium channel blocker that has been used to treat ventricular tachyarrhythmias since 1999 in Japan. Intravenous amiodarone was approved later than nifekalant in Japan, and it is still unclear which of the two agents is superior. The aim of this study was to compare the efficacy of nifekalant and amiodarone for resuscitation of out-of-hospital cardiopulmonary arrest caused by shock-resistant ventricular fibrillation.
  
  
  METHODS
  From December 2005 to January 2011, ambulance services transported 283 out-of-hospital cardiopulmonary arrest patients to our hospital. Of these, 25 patients were treated with nifekalant or amiodarone in response to ventricular fibrillation that was resistant to two or more shocks. We undertook a retrospective analysis of these 25 patients.
  
  
  RESULTS
  We enrolled 20 men and 5 women with a mean age (± standard deviation) of 61.1 ± 16.4 years. All 25 patients were treated with tracheal intubation and intravenous epinephrine. Fourteen patients received nifekalant and 11 patients received amiodarone. The rates of return of spontaneous circulation (ROSC) (nifekalant, 5/14, versus amiodarone, 4/11; P = 0.97) and survival to discharge (nifekalant, 4/14, versus amiodarone, 2/11; P = 0.89) were not significantly different between the two groups. The time from nifekalant or amiodarone administration to ROSC was 6.0 ± 6.6 and 20.3 ± 10.0 min, respectively, which was significantly different (P < 0.05).
  
  
  CONCLUSIONS
  In this small sample size study, nifekalant, compared with amiodarone, is equally effective for ROSC and survival to discharge after shock-resistant ventricular fibrillation and can achieve ROSC more quickly. Further prospective studies are needed to confirm our results.
authors.affiliation: Critical Care Medicine, University Hospital, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan, nobuya@med.uoeh-u.ac.jp.
authors.forename: Nobuya
authors.initials: N
authors.lastname: Harayama
authors.forename: Shun-ichi
authors.initials: S
authors.lastname: Nihei
authors.forename: Keiji
authors.initials: K
authors.lastname: Nagata
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Isa
authors.forename: Kei
authors.initials: K
authors.lastname: Goto
authors.forename: Keiji
authors.initials: K
authors.lastname: Aibara
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kamochi
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Sata
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004554:Electric Countershock; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D011744:Pyrimidinones / Q000627:therapeutic use*; D012189:Retrospective Studies; D014693:Ventricular Fibrillation / Q000150:complications*
chemical_list: D000889:Anti-Arrhythmia Agents; D011744:Pyrimidinones; C076259:nifekalant; D000638:Amiodarone