Administration of amiodarone during resuscitation of ventricular arrhythmias.

Amiodarone is an antiarrhythmic drug indicated in the treatment of ventricular arrhythmias. Early studies evaluating amiodarone for the management of ventricular arrhythmias demonstrated the efficacy of amiodarone in patients who were refractory to treatment with multiple antiarrhythmic drugs. More recently, 2 major trials, published in 1999 and 2002, described the efficacy of amiodarone as a primary treatment modality in the treatment of ventricular arrhythmias compared with another antiarrhythmic drug, lidocaine, and placebo. As a result of this literature, the American Heart Association Advanced Cardiac Life Support (ACLS) guidelines recommend amiodarone as the antiarrhythmic of choice in the resuscitation of patients with ventricular arrhythmias. The use of amiodarone for the emergent treatment of ventricular arrhythmias, including ventricular tachycardia and ventricular fibrillation, has steadily increased in recent years. This increased use is a result of emerging literature relating to the efficacy of amiodarone, combined with the updated ACLS treatment guidelines available from the American Heart Association. In the setting of cardiac emergency (eg, ventricular tachycardia with a palpable pulse), the recommended dose of intravenous amiodarone is 150 mg. In cardiac arrest (eg, ventricular fibrillation), the recommended dose of amiodarone is 300 mg administered intravenously, followed by a subsequent dose of 150 mg as needed for sustained arrhythmia. In the 2005 American Heart Association guidelines, the recommendation for administration of amiodarone is as an intravenous bolus dose. In the typical medical setting, the preferred standard of practice is to prepare an infusion of amiodarone diluted in 5% dextrose in water placed in a polyolefin bag, administered through an in-line filter via a central vein or large peripheral vein. However, in the setting of cardiac emergency, administration by prolonged infusion is not desirable. The vast differences in the recommendations for administration of amiodarone in this setting have raised significant questions in the medical community.