Cardiac Arrest in Seattle: Conventional versus Amiodarone Drug Evaluation Study - CASCADE

Jul 10, 2003
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Date Published:
01/01/1993
Date Updated:
07/10/2003
Original Posted Date:
07/10/2003
References

Description:

Amiodarone for cardiac mortality after cardiac arrest.

Hypothesis:

Amiodarone provides superior survival compared to conventional antiarrhythmic drugs.

Study Design

Patients Screened: Not given
Patients Enrolled: 228
Mean Follow Up: Not given
Mean Patient Age: 62
Female: 11
Mean Ejection Fraction: 0.35

Patient Populations:

Previously resuscitated from out-of-hospital VF not associated with acute Q-wave MI

Exclusions:

Reversible primary cause of VF
Evidence of associated new Q-wave MI

Primary Endpoints:

Cardiac mortality
Resuscitated cardiac arrest due to documented VF
Complete syncope followed by a shock from an implanted automatic defibrillator

Drug/Procedures Used:

Amiodarone, 1200 mg/day for up to 10 days, then 200-800 mg qd (600 mg mean) orally for 1-2 months. Doses tapered off to maintenance dose of 100-400 mg qd.

Concomitant Medications:

Concomitant therapy: 105 patients (46%) also received an ICD

Principal Findings:

Pulmonary toxicity with amiodarone was 7% at 1 year and 11% at 3 years, but no patients died as a result.

Survival free of cardiac death, resuscitated VF, or syncopal defibrillator shock (p = 0.007):
At 2 years, entire population 75%; amiodarone 82%; conventional, 69%
At 4 years, entire population 59%; amiodarone 66%; conventional, 52%
At 6 years, entire population 46%; amiodarone 53%, conventional, 40%

Survival free of cardiac death and sustained ventricular arrhythmias (p = 0.001):
At 2 years, entire population 65%; amiodarone 78%; conventional, 52%
At 4 years, entire population 43%; amiodarone 52%; conventional, 36%
At 6 years, entire population 30%; amiodarone 41%, conventional, 20%

Interpretation:

Amiodarone is more effective than conventional antiarrhythmic agents in survivors of cardiac arrest.

References:

1. Am J Cardiol 1991;67:578-584. Design and baseline characteristics
2. Am J Cardiol 1993;72:280-287. Final Results
3. Am J Cardiol 1994;73:237-241. Clinical predictors of ICD shocks

Keywords: Defibrillators, Procainamide, Quinidine, Tocainide, Ventricular Fibrillation, Heart Arrest, Survivors, Encainide, Tachycardia, Ventricular, Disopyramide, Flecainide


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