The Effect of Time to Treatment with Antiarrhythmic Drugs on Outcomes in Shock Refractory Out-of-hospital Cardiac Arrest: A Secondary Analysis of the Amiodarone, Lidocaine, Placebo Study (ALPS) Randomized Controlled Trial

Background: In patients with shock refractory out-of-hospital cardiac arrest (OHCA), antiarrhythmic drugs are used to improve the defibrillation success and/or prevent re-fibrillation. Currently, the relationship between time to treatment in patients with OHCA and survival outcomes, and the interaction of time to treatment and antiarrhythmic drug effect, is not precisely known. Method: We conducted a post-hoc analysis of the Resuscitation Outcomes Consortium Amiodarone, Lidocaine, Placebo (ROC ALPS) randomized controlled trial examining the association of time to treatment (drug or placebo) with survival outcomes. Results: In our study, the probability of survival at hospital discharge decreased with a longer interval from a 911 call to receipt of amiodarone, lidocaine, or placebo. Only amiodarone improved survival over placebo at all time points; the effect of lidocaine, but not amiodarone, on increasing the probability of survival at hospital discharge varied based on the interval from 911 call to receipt of the drug.M.Sc