Abstract 236: Administration of Amiodarone During Resuscitation Is Associated with Higher TNF-? Levels in the Early Postarrest Period in the Swine Model of Ischemic Ventricular Fibrillation

Introduction: While amiodarone (AMIO) improves ROSC from cardiac arrest due to VF when compared to lidocaine (L), no long-term survival benefit has been demonstrated. Conflicting data exist regarding the effects of AMIO on serum TNF-alpha levels in settings such as cardiopulmonary bypass and CHF. We hypothesized that AMIO administration during resuscitation from VF would result in a TNF-alpha response comparable to L in the early post-arrest period. Methods: Balloon occlusion of the LAD was used to induce VF in anesthetized, instrumented swine. After 7 min, conventional ACLS was begun. Animals were randomized to either bolus AMIO (5 mg/kg, n=13) or L (1 mg/kg, n=14) for recurrent or refractory VF. Following ROSC, TNF-alpha levels were drawn at 30 and 60 min for analysis. Results: Groups demonstrated comparable prearrest hemodynamics and resuscitation variables. Prearrest TNF-alpha levels were higher, however, in animals ultimately treated with AMIO (geometric mean of 103.0 vs. 58.8 pg/mL, p=0.01). In the postarrest period, TNF-alpha levels were significantly higher in AMIO than L treated animals at 30 min (2.2 fold higher, 95% CI 1.4-3.4 fold higher, p=0.0016) and at 60 min (2.65 fold higher, 95% CI 1.1-6.3 fold higher, p=0.03). The rate of rise in TNF-alpha among AMIO-treated animals was higher than that in L treated animals by, on average, 1 pg/mL/minute, but this difference in slope was not statistically significant (p=0.4). (Figure) Conclusion: Higher post arrest TNF-alpha levels in AMIO treated animals may mean that improved rates of ROSC seen with AMIO come at the expense of a heightened pro-inflammatory state in the post-cardiac arrest period.