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EMS A to Z: Amiodarone
EMS A to Z: Amiodarone
Show Notes:
From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn
Mechanism of Action:
Amiodarone is classified as an antiarrhythmic drug. It is a “dirty drug” in that it acts on multiple different receptors including sodium channels, potassium channels, beta-receptors, and calcium channel receptors.
Overall, amiodarone prolongs what’s called the “refractory period” in which the cardiac musculature is unable to contract or generate another beat. Prolonging this period works to prevent tachyarrhythmias, like Vtach or Vfib.
Indications:
Amiodarone is indicated for tachyarrhythmias including: Vtach, Vfib, Afib with RVR, depending on the circumstance and patient presentation.
We can divide the indications into two major categories: cardiac arrest and non-cardiac arrest.
The AHA recommends considering amiodarone or lidocaine in cardiac arrest with a shockable rhythm after the 2nd shock has been delivered. Our AGs allow for administration of amiodarone / lidocaine for refractory VTACH / Vfib not responding to defibrillation.
Administration of amiodarone should not take priority over good cardiac arrest care, like CPR and defibrillation.
Side Effects:
Rapid administration of amiodarone can cause hypotension.
Amiodarone can prolong the QTc interval.
What about lidocaine?
Lidocaine also acts on the sodium channel to prolong the refractory period but does not have many of the other effects of amiodarone.
A NEJM study of amiodarone vs lidocaine vs placebo in OHCA did not show significant mortality benefit overall to either medication; this is consistent with prior studies as well. Both medications seem to terminate the rhythm and improve survival to admission and did improve survival to discharge in patients with a witnessed arrest. It’s possible that the study wasn’t large enough to detect a small difference in survival.
Fast Facts:
Amoidarone can be administered IV or IO, so drill away.
The initial dose is 5mg/kg or up to 300mg initially in cardiac arrest with a follow up dose of 2.5mg/kg up to 150mg if a 2nddose is needed.
In patients with a pulse, the dose is 2.5mg/kg up to 150mg given over 10 min.
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By EMSAtoZ
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EMS A to Z: Amiodarone
Show Notes:
From your hosts, Dr. Josh Gaither, Dr. Amber Rice, and Dr. Rachel Munn
Mechanism of Action:
Amiodarone is classified as an antiarrhythmic drug. It is a “dirty drug” in that it acts on multiple different receptors including sodium channels, potassium channels, beta-receptors, and calcium channel receptors.
Overall, amiodarone prolongs what’s called the “refractory period” in which the cardiac musculature is unable to contract or generate another beat. Prolonging this period works to prevent tachyarrhythmias, like Vtach or Vfib.
Indications:
Amiodarone is indicated for tachyarrhythmias including: Vtach, Vfib, Afib with RVR, depending on the circumstance and patient presentation.
We can divide the indications into two major categories: cardiac arrest and non-cardiac arrest.
The AHA recommends considering amiodarone or lidocaine in cardiac arrest with a shockable rhythm after the 2nd shock has been delivered. Our AGs allow for administration of amiodarone / lidocaine for refractory VTACH / Vfib not responding to defibrillation.
Administration of amiodarone should not take priority over good cardiac arrest care, like CPR and defibrillation.
Side Effects:
Rapid administration of amiodarone can cause hypotension.
Amiodarone can prolong the QTc interval.
What about lidocaine?
Lidocaine also acts on the sodium channel to prolong the refractory period but does not have many of the other effects of amiodarone.
A NEJM study of amiodarone vs lidocaine vs placebo in OHCA did not show significant mortality benefit overall to either medication; this is consistent with prior studies as well. Both medications seem to terminate the rhythm and improve survival to admission and did improve survival to discharge in patients with a witnessed arrest. It’s possible that the study wasn’t large enough to detect a small difference in survival.
Fast Facts:
Amoidarone can be administered IV or IO, so drill away.
The initial dose is 5mg/kg or up to 300mg initially in cardiac arrest with a follow up dose of 2.5mg/kg up to 150mg if a 2nddose is needed.
In patients with a pulse, the dose is 2.5mg/kg up to 150mg given over 10 min.