prehospital use of AMIODARONE

[mike m]

I WOULD APPRECIATE ANY IN PUT ANYONE CAN GIVE ME ON THE PREHOSPITAL USE OF AMIODARONE.ESPECIALLY IN V FIB ARRESTS VERSUS LIDOCAINE OR ANY OTHER FIRST LINE THAT YOU MAY HAVE USED.ALSO THE OUTCOME WHERE YOU MIGHT HAVE USED IT IN A WITNESSED ARREST OR FURTHER ON IN AN ONGING ARREST

[TommyB]

Sorry I can't give you too many specifics, since I am an EMT-B, not a paramedic. We had our county's first amiodarone assisted save a couple of weeks ago. Witnessed arrest, pt in fine vfib (57yo Male, no previous hx)upon our arrival. Repeated shocks (I think 7-8 total), and normal cardiac drugs delivered intravaenously (I believe atropine & lidocaine), and he wasn't converting. After 2 doses of amiodarone he converted. Had BP above 140, spontaeneous respirations and palpable radial pulse. He's home from the hospital now.

[pro474]

I had a 54 y/o male unknown down time at work. We arrived (als) and found fire delivering 2nd shock using saed. After stacked shocks pt. was intubated and IV was established. Epi and a 360J shock was given followed by amiodarone. Pt. had recurring vf with ivr rhythms. acls protocols were followed. We left hospital with pt in sinus tach (130) b/p 160/100. My first experience with amiodarone was a success. hopefully more. Thanks

[DCFyrMdc]

Amiodarone....is different everywhere depending on your Medical Director, but in JEMS (I think)....they reported it being used in Richmond VA right behine Epinephrine....i.e. 200-300-360 of shocking, ET, IV, Epi 1 mg 1:10000 followed by 300 mg of Amiodarone over 2 minutes. CPR is ongoing and then shock again. I don't know the full algorithm they use and haven't seen our new protocol on it yet.

Mainly I hear it's a "make peace" drug that works for 3-4 days but after that you're going to die. If you don't have your affairs in order, well, now's the time if you come back with it. I haven't heard any news about long term success with it but there is certainly a trio of anti-amiodarone docs out there who basically say it's not the wonderdrug people think it is. It might look that way in the field, but what about the patient.

Also, you said this was a witnessed arrest, I'm wondering how much of a positive effect good first responder CPR or CPR by phone instruction was given. Did this patient convert because of the amiodarone or good basics and good early defib?

Stay safe.

[needles]

we use amio in our system, it has replaced bretilium as a front line cardiac drug , also I believe its on its way to replace lido. we have had good results, i haven't heard the 3or 4 days and your dead story and don 't buy it either. we use 300mg diluted in 20cc ns iv push, also on 2 occasions we push it straight also with good results, later we talked to the amiodarone rep at a M&M confrence and he said that would not be a problem. we are now talking to our MD director to change the protocal so we can admin straight , saves time

[ERIC W. HOLLENBECK]

Hey Mike I'm new at this so bear with me. I'm a professional Paramedic/Firefighter in Ohio and we use Amiodorone in our protocol. The way we use it is in a single 300mg. dose pushed IVP in a V-Fib situation right behind 1:10000 Epi. then we go into the regular Lidocain route. However my partner and I elect to use Lidocain first off to abolish any ectopy only because we can get it onboard faster than Amiodorone which takes 10-12 min. to push in a non-arrest situation. A few months ago JEMS had an article on lido vs. Amiodorone, and while Amiodorone is far better than lido is initially there was little difference in the number of people walking out the hospital door. Well gotta go and remember DON'T LIKE THE PADDLES IT HURTS.