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Monroe Community College
Rochester, New York
MCC Paramedic Program
Trade Name: Cordarone®
FDA Category: Anti-Arrhythmic
FDA Pregnancy class: D
Action: Amiodarone acts by prolonging the phase 3 potential and is a class III antiarrhythmic.
The addition of Amiodarone to the Latest AHA Guidelines is based largely on its performance in the 1995-1997 ARREST Trial (Amiodarone in out of hospital Resuscitation of REfractory Sustained ventricular Tachyarrhythmias) reported last year in the New England Journal of Medicine.
This study compared two groups of patients suffering from out of hospital cardiac arrest. One group received Amiodarone and the other received placebo. The Amiodarone treated group was more likely to survive to hospital admission, the end point of the study. (44% vs. 34% P=0.03)
Amiodarone as a medication is not new. It has been available as an oral agent since 1967 (for angina) and as an IV preparation since 1995. It has been used successfully for the most severe life threatening ventricular arrhythmias. Long term use of oral Amiodarone can lead to life ending compications such as pulmonary fibrosis and occasionally pro-arrhythmia especially Torsades de pointes. The short term use in critical emergency medical situations appears not to carry these risks.
Dosing Information: For Pulseless VT/Vf that have failed rapid defibrillation and standard treatments (i.e. ET, IV Epinephrine or Vasopressin) give adults 300 mg of Amidarone diluted in 30 cc of saline or D5W over one minute. Proceed with appropriate defibrillations. Supplementary rapid infusions of 150 mg in 15ccs can be given if the Vf/VT is recurrent or refractory. IV maintenance is 1 mg/ min over the first 6 hours then half that beyond 6 hours. Consult your local protocols or Medical Control for indications and dosing.
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Author: Peter Bonadonna, EMT-P
Updated: Nov. 01, 2000