• Journal of critical care · Oct 2012

    Multicenter Study Clinical Trial

    Prehospital amiodarone may increase the incidence of acute respiratory distress syndrome among patients at risk.

    • Lioudmila V Karnatovskaia, Emir Festic, Ognjen Gajic, Rickey E Carter, Augustine S Lee, and US Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG-LIPS).
    • Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA. Karnatovskaia.Lioudmila@mayo.edu
    • J Crit Care. 2012 Oct 1;27(5):447-53.

    PurposeAmiodarone has been implicated as a risk factor for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) when used in the hospital. This study aims to estimate whether prehospital amiodarone also increases the risk of ALI/ARDS.MaterialsAdult patients admitted to 22 centers with at least 1 risk factor for developing ALI were recruited. In a secondary analysis of this cohort, the prehospital use of amiodarone was documented on admission, and the patients followed for the primary outcome of ALI and secondary outcomes of ARDS, the need for invasive ventilation, and mortality. Dose/duration of amiodarone therapy was not available. Propensity matching was performed to account for imbalances in being assigned to amiodarone. The adjusted risk for ALI/ARDS was then estimated from a conditional logistic regression model of this propensity-matched set.ResultsForty of 5584 patients were on amiodarone at the time of hospitalization; of those, 6 developed ALI, with 5 progressing to ARDS. In comparison, 371 patients not on amiodarone developed ALI, with 224 having ARDS. After propensity score matching, the prehospital use of amiodarone was not statistically associated with an increased risk for all ALI (odds ratio [OR], 1.8; 95% confidence interval [CI], 0.7-5.0; P = .25), invasive ventilation (OR, 1.9; 95% CI, 1.0-3.6; P = .059), or in-hospital mortality (OR, 1.2; 95% CI, 0.5-2.9; P = .75); but its use appeared to significantly increase the risk for ARDS (OR 3.8; 95% CI, 1.1-13.1; P = .036).ConclusionsPrehospital use of amiodarone may independently increase the risk for ARDS in patients who have at least 1 predisposing condition for ALI.Copyright © 2012 Elsevier Inc. All rights reserved.

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