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Postresuscitation Antiarrhythmic Drugs

Question Type:
Intervention
Full Question:
Among adults with ROSC after cardiac arrest in any setting  (P), does do prophylactic antiarrhythmic drugs given immediately after ROSC  (I), compared with compared with not giving antiarrhythmic drugs  (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, development of cardiac arrest, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, recurrence of VF, incidence of arrhythmias (O)?
Consensus on Science:
β-Blockers (I) Versus No β-Blockers (C) For the critical outcome of survival at 6 months, we have identified very-low-quality evidence (downgraded for serious risk of bias, indirectness, and imprecision) from 1 observational study of 98 patients resuscitated from OHCA showing a higher rate of survival with administration of β-blockers (metoprolol or bisoprolol) for 72 hours after ROSC compared with no drug (55.7% versus 21.1%; P
Treatment Recommendation:
We make no recommendation about the routine prophylactic use of antiarrhythmic drugs post after ROSC (GRADE used for evidence evaluation and synthesis only, very low confidence in effect estimate). Values, Preferences, and Task Force Insights The available data were too limited to have any confidence in any effect, and, therefore, no recommendation is made. We also place value on avoiding known side effects of medications when the treatment effect was unproven or unknown. The studies evaluated were all observational, and no causal relation could be determined. Moreover, they were performed before changes in current practice (ie, currently amiodarone is used during cardiac arrest more than lidocaine).
CoSTR Attachments:
CoSTR Statement - ALS 493 Antiarrhythmic drugs post resuscitation 20150110.docx    
Pellis - Grade Table.docx    

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