Abstract:
BACKGROUND:Out-of-hospital cardiac arrest (OHCA) commonly presents with nonshockable rhythms (asystole and pulseless electric activity). It is unknown whether antiarrhythmic drugs are safe and effective when nonshockable rhythms evolve to shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia [VF/VT]) during resuscitation. METHODS:Adults with nontraumatic OHCA, vascular access, and VF/VT anytime after ≥1 shock(s) were prospectively randomized, double-blind, to receive amiodarone, lidocaine, or placebo by paramedics. Patients presenting with initial shock-refractory VF/VT were previously reported. The current study was a prespecified analysis in a separate cohort that initially presented with nonshockable OHCA and was randomized on subsequently developing shock-refractory VF/VT. The primary outcome was survival to hospital discharge. Secondary outcomes included discharge functional status and adverse drug-related effects. RESULTS:Of 37 889 patients with OHCA, 3026 with initial VF/VT and 1063 with initial nonshockable-turned-shockable rhythms were treatment-eligible, were randomized, and received their assigned drug. Baseline characteristics among patients with nonshockable-turned-shockable rhythms were balanced across treatment arms, except that recipients of a placebo included fewer men and were less likely to receive bystander cardiopulmonary resuscitation. Active-drug recipients in this cohort required fewer shocks, supplemental doses of their assigned drug, and ancillary antiarrhythmic drugs than recipients of a placebo (P<0.05). In all, 16 (4.1%) amiodarone, 11 (3.1%) lidocaine, and 6 (1.9%) placebo-treated patients survived to hospital discharge (P=0.24). No significant interaction between treatment assignment and discharge survival occurred with the initiating OHCA rhythm (asystole, pulseless electric activity, or VF/VT). Survival in each of these categories was consistently higher with active drugs, although the trends were not statistically significant. Adjusted absolute differences (95% confidence interval) in survival from nonshockable-turned-shockable arrhythmias with amiodarone versus placebo were 2.3% (-0.3, 4.8), P=0.08, and for lidocaine versus placebo 1.2% (-1.1, 3.6), P=0.30. More than 50% of these survivors were functionally independent or required minimal assistance. Drug-related adverse effects were infrequent. CONCLUSIONS:Outcome from nonshockable-turned-shockable OHCA is poor but not invariably fatal. Although not statistically significant, point estimates for survival were greater after amiodarone or lidocaine than placebo, without increased risk of adverse effects or disability and consistent with previously observed favorable trends from treatment of initial shock-refractory VF/VT with these drugs. Together the findings may signal a clinical benefit that invites further investigation. CLINICAL TRIAL REGISTRATION:URL: https://www.clinicaltrials.gov. Unique identifier: NCT01401647.
journal_name
Circulationjournal_title
Circulationauthors
Kudenchuk PJ,Leroux BG,Daya M,Rea T,Vaillancourt C,Morrison LJ,Callaway CW,Christenson J,Ornato JP,Dunford JV,Wittwer L,Weisfeldt ML,Aufderheide TP,Vilke GM,Idris AH,Stiell IG,Colella MR,Kayea T,Egan D,Desvigne-Nickdoi
10.1161/CIRCULATIONAHA.117.028624subject
Has Abstractpub_date
2017-11-28 00:00:00pages
2119-2131issue
22eissn
0009-7322issn
1524-4539pii
CIRCULATIONAHA.117.028624journal_volume
136pub_type
杂志文章,多中心研究,随机对照试验相关文献
CIRCULATION文献大全abstract::Although thrombolytic therapy has been a major advance in the treatment of acute myocardial infarction, in at least 25% of patients the artery remains occluded after administration. In these patients, the strategy of "rescue" or "salvage" angioplasty is frequently used although follow-up data are limited. Sixty-three ...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1990-03-01 00:00:00
abstract:BACKGROUND:Genetic polymorphisms at codons 16 and 27 of the beta2-adrenergic receptor have been associated with altered response to sympathetic stimulation. We examined these polymorphisms in relation to cardiovascular event risk in the Cardiovascular Health Study. METHODS AND RESULTS:A total of 808 black and 4441 whi...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000065231.07729.92
更新日期:2003-04-22 00:00:00
abstract::Reperfusion of the globally ischemic myocardium with mannitol has been shown to preserve myocardial function. However, it remains unclear whether the mechanism of mannitol protection relates to its hyperosmolar or free radical scavenging properties. Three groups of isolated, perfused rabbit hearts underwent 45 min of ...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1985-09-01 00:00:00
abstract:BACKGROUND:Heme oxygenase-1 (HO-1) catalyzes the degradation of heme into biliverdin, iron, and carbon monoxide (CO). Although HO-1 is induced in vascular smooth muscle cells (SMCs), the biological role of HO-1 in these cells has not been completely characterized. METHODS AND RESULTS:In the present study, we overexpre...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/hc0102.101369
更新日期:2002-01-01 00:00:00
abstract::In vitro experiments on precontracted canine coronary arteries were performed to study the direct relaxant effects of molsidomine (MOLS) and its active metabolite, SIN-1, and to determine if there is a relationship between effect and cGMP level elevations. The effects of MOLS and SIN-1 were compared with those of a cl...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.68.6.1315
更新日期:1983-12-01 00:00:00
abstract:BACKGROUND:Recognition of rates and causes of hard, patient-centered outcomes of death and cerebrovascular events (CVEs) after heart rhythm disorder management (HRDM) procedures is an essential step for the development of quality improvement programs in electrophysiology laboratories. Our primary aim was to assess and ...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCULATIONAHA.117.030523
更新日期:2018-01-02 00:00:00
abstract::Between July 1985 and September 1987, 25 patients underwent 26 carotid endarterectomies based on an abnormal duplex scan (B-mode ultrasonography and pulsed-Doppler sound spectral analysis) indicative of severe stenosis or ulceration. Arteriography was not performed because of severe unstable angina requiring coronary ...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1988-09-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to compare differential effects of a segment of slow conduction during ventricular tachycardia (VT) due to depression of the action potential and electrical uncoupling. METHODS AND RESULTS:In 33 Langendorff-perfused rabbit hearts, a ring of anisotropic left ventricular subepica...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.99.7.949
更新日期:1999-02-23 00:00:00
abstract:BACKGROUND:Posteroseptal ablation of the atrioventricular node (AVN) has been proposed as a means to slow the ventricular rate during atrial fibrillation (AF). The suggested mechanism is elimination of the AVN "slow pathway." On the basis of the unpredictable success of the procedure, we hypothesize that, in fact, the ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.99.17.2323
更新日期:1999-05-04 00:00:00
abstract::Myocardial lactate production indicates anaerobic metabolism resulting from hypoxia or anoxia. Clinically, myocardial lactate extraction of less than 10% has also been used as an indicator of ischemia. Sixteen healthy young male volunteers underwent coronary sinus and aterial catheterization. A coronary sinus pacing c...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.61.2.256
更新日期:1980-02-01 00:00:00
abstract:BACKGROUND:Thrombus formation within a coronary vessel is the acute precipitating event in most acute coronary syndromes. Recently, constitutive nitric oxide synthase (cNOS) has been identified in human platelets, and platelet-derived nitric oxide has been shown to inhibit platelet recruitment after aggregation. Howeve...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.98.15.1481
更新日期:1998-10-13 00:00:00
abstract:BACKGROUND:Aprotinin was a commonly used pharmacological agent for homeostasis in cardiac surgery but was discontinued, resulting in the extensive use of lysine analogues. This study tested the hypothesis that early postoperative adverse events and blood product utilization would affected in this post-aprotinin era. M...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.110.002543
更新日期:2011-09-13 00:00:00
abstract:BACKGROUND:One or more brief episodes of coronary artery occlusion protect or "precondition" the myocardium perfused by that artery from a subsequent episode of sustained ischemia. We sought to determine whether ischemic preconditioning protects only those myocytes subjected to brief coronary occlusion or whether brief...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.87.3.893
更新日期:1993-03-01 00:00:00
abstract:BACKGROUND:In patients with neurogenic orthostatic hypotension (NOH), the availability of the sympathetic neurotransmitter norepinephrine (NE) in the synaptic cleft is insufficient to maintain blood pressure while in the standing posture. METHODS AND RESULTS:We determined the effect of oral administration of the synth...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.CIR.0000083721.49847.D7
更新日期:2003-08-12 00:00:00
abstract:BACKGROUND:Transfer of the coronary arteries is a crucial step during the arterial switch operation (ASO) for transposition of the great arteries. This retrospective study aims to assess the incidence and risk factors of coronary events after ASO and sensitivity of noninvasive tests in the diagnosis of the coronary obs...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000087902.67220.2b
更新日期:2003-09-09 00:00:00
abstract:BACKGROUND:Recombinant staphylokinase (STAR) was shown recently to offer promise for coronary arterial thrombolysis in patients with evolving myocardial infarction. The present multicenter randomized open trial was designed to assess the thrombolytic efficacy, safety, and fibrin specificity of STAR relative to accelera...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1161/01.cir.92.8.2044
更新日期:1995-10-15 00:00:00
abstract:BACKGROUND:Monocarboxylate transporters (MCTs) mediate lactate transport across the plasma membrane of cells. The molecular mechanisms regulating monocarboxylate transport in smooth muscle cells (SMCs) remain poorly characterized. The aim of this study was to investigate the effects of DNA methylation on MCT expression...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.104.519025
更新日期:2005-08-30 00:00:00
abstract:BACKGROUND:Contrary to expectation, most studies have demonstrated that initiation of an angiotensin-converting enzyme (ACE) inhibitor in conventional doses in patients with heart failure reduces the diuretic efficacy of furosemide. Recently, it has been suggested that single low doses (1 mg) but not high doses (25 mg)...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.90.1.220
更新日期:1994-07-01 00:00:00
abstract::Prognostic stratification was carried out on 518 patients less than or equal to 65 years of age who were discharged from the hospital following a definite or probable acute myocardial infarction and followed for four months. The total population was made up of 272 patients hospitalzed in 1973 and 246 patients hospital...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.54.1.58
更新日期:1976-07-01 00:00:00
abstract:BACKGROUND:A variable degree of smooth muscle cell (SMC) proliferation after balloon injury has been reported in previous rat studies. It is unknown whether balloon injury induces c-fos expression and whether it is related to the degree of vascular injury in vivo. Therefore, we tested the hypothesis that proportional i...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.92.5.1230
更新日期:1995-09-01 00:00:00
abstract::We used Doppler echocardiography to quantitate the changes in intracardiac blood flow velocities and right and left ventricular stroke volumes in 80 normal human fetuses from 19 to 40 weeks gestation. Blood flow velocity spectra across the aortic, pulmonary, tricuspid, and mitral valves were digitized to obtain peak v...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.74.6.1208
更新日期:1986-12-01 00:00:00
abstract:BACKGROUND:Despite improvements in management, infective endocarditis remains associated with high mortality and morbidity. We describe temporal changes in the incidence, microbiology, and outcomes of infective endocarditis and the effect of changes in national antibiotic prophylaxis guidelines on incident infective en...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.119.044913
更新日期:2020-06-23 00:00:00
abstract:BACKGROUND:Gallbladder pathology has been associated with cardiovascular disease. Recently, we showed that gallbladder distension in anesthetized pigs reflexly increased heart rate, arterial pressure, and coronary and renal vascular resistance through efferent sympathetic mechanisms. Renin release is affected by sympat...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.101.21.2539
更新日期:2000-05-30 00:00:00
abstract:BACKGROUND:Cardiovascular disease is the major cause of death in older women. Information on the relation of menopause and hormone replacement therapy with carotid atherosclerosis is limited. METHODS AND RESULTS:We examined cross-sectionally the association of menopausal status, years since last menstruation, and horm...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.94.8.1857
更新日期:1996-10-15 00:00:00
abstract:BACKGROUND:Congestive heart failure (CHF) in humans is associated with a marked sympathoexcitation, including an augmented muscle sympathetic nerve activity (MSNA) in intraneural multiunit recordings. In the present study, single-unit recording was used to evaluate whether the firing properties of individual muscle vas...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.100.16.1708
更新日期:1999-10-19 00:00:00
abstract::This study describes the efficacy of the right gastroepiploic artery (GEA) as graft material for coronary artery bypass grafting (CABG) as assessed by exercise thallium 201 myocardial scintigraphy in eight patients (age, 59.4 +/- 9.35 years [mean +/- SD]) who underwent CABG with the GEA graft in the past 2 years. Plan...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1989-09-01 00:00:00
abstract:BACKGROUND:Chronic orthostatic intolerance (COI) is a debilitating autonomic condition in young adults. Its neurohumoral and hemodynamic profiles suggest possible alterations of postural sympathetic function and of baroreflex control of heart rate (HR). METHODS AND RESULTS:In 16 COI patients and 16 healthy volunteers,...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.98.20.2154
更新日期:1998-11-17 00:00:00
abstract:BACKGROUND:In the past few years, although significant efforts have been made to assess flow distribution during retrograde cerebral perfusion with microspheres, dye, or hydrogen clearance, flow distribution in real time is still undefined. We used MR perfusion imaging to monitor flow distribution in the brain during a...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1998-11-10 00:00:00
abstract::The effects of encainide on ventricular arrhythmia and left ventricular function were studied in 21 patients with chronic, high-grade ventricular arrhythmia using a prospective, 3-month, placebo-controlled, single-blind trial design. Encainide caused a 96% decrease in the average hourly frequency of ventricular premat...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.65.6.1134
更新日期:1982-06-01 00:00:00
abstract:BACKGROUND:Pathological cardiac hypertrophy induced by stresses such as aging and neurohumoral activation is an independent risk factor for heart failure and is considered a target for the treatment of heart failure. However, the mechanisms underlying pathological cardiac hypertrophy remain largely unknown. We aimed to...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.117.028728
更新日期:2017-11-21 00:00:00