Can Nifekalant Hydrochloride be Used as a First-Line Drug for Cardiopulmonary Arrest (CPA)? Comparative Study of Out-of-Hospital CPA With Acidosis and In-Hospital CPA Without Acidosis

Koichiro Yoshioka; Mari Amino; Seiji Morita; Yoshihide Nakagawa; Kazutane Usui; Atsuhiko Sugimoto; Atsushi Matsuzaki; Yoshiaki Deguchi; Isotoshi Yamamoto; Sadaki Inokuchi; Yuji Ikari; Itsuo Kodama; Teruhisa Tanabe

doi:10.1253/circj.70.21

Clinical Investigation

Can Nifekalant Hydrochloride be Used as a First-Line Drug for Cardiopulmonary Arrest (CPA)?

Comparative Study of Out-of-Hospital CPA With Acidosis and In-Hospital CPA Without Acidosis

Koichiro Yoshioka, Mari Amino, Seiji Morita, Yoshihide Nakagawa, Kazutane Usui, Atsuhiko Sugimoto, Atsushi Matsuzaki, Yoshiaki Deguchi, Isotoshi Yamamoto, Sadaki Inokuchi, Yuji Ikari, Itsuo Kodama, Teruhisa Tanabe

Author information

Koichiro Yoshioka
Departments of Cardiology
Mari Amino
Departments of Cardiology
Seiji Morita
Emergency and Critical Care Medicine, Tokai University School of Medicine
Yoshihide Nakagawa
Emergency and Critical Care Medicine, Tokai University School of Medicine
Kazutane Usui
Departments of Cardiology
Atsuhiko Sugimoto
Departments of Cardiology
Atsushi Matsuzaki
Departments of Cardiology
Yoshiaki Deguchi
Departments of Cardiology
Isotoshi Yamamoto
Emergency and Critical Care Medicine, Tokai University School of Medicine
Sadaki Inokuchi
Emergency and Critical Care Medicine, Tokai University School of Medicine
Yuji Ikari
Departments of Cardiology
Itsuo Kodama
Research Institute of Environmental Medicine, Nagoya University
Teruhisa Tanabe
Departments of Cardiology

Keywords: Acidosis, Cardiopulmonary resuscitation, Nifekalant hydrochloride, QT prolongation, Ventricular fibrillation

JOURNAL FREE ACCESS

2006 Volume 70 Issue 1 Pages 21-27

DOI https://doi.org/10.1253/circj.70.21

Details

Abstract

Background Early defibrillation of ventricular tachycardia and fibrillation (VT/VF) is an urgent and most important method of resuscitation for survival in cardiopulmonary arrest (CPA). We have previously reported that nifekalant (NIF), a specific I_Kr blocker developed in Japan, is effective for lidocaine (LID) resistant VT/VF in out-of-hospital CPA (OHCPA). However, little is known about the differences in the effect of NIF on OHCPA with acidosis and in-hospital CPA (IHCPA) without acidosis. Methods and Results The present study enrolled 91 cases of DC shock resistant VT/VF among 892 cases of CPA that occurred between June 2000 and May 2003. NIF was used (0.15-0.3 mg/kg) after LID according to the cardiopulmonary resuscitation (CPR) algorithm of Tokai University. The defibrillation rate was higher in the NIF group for both OHCPA and IHCPA than for LID alone, and the VT/VF rate reduction effect could be maintained even with acidosis. However, sinus bradycardia in OHCPA, and torsades de pointes in IHCPA were occasionally observed. These differences in adverse effects might be related to the amount of epinephrine, serum potassium levels, serum pH, and interaction with LID. Conclusions NIF had a favorable defibrillating effect in both CPA groups, and it shows promise of becoming a first-line drug for CPR. (Circ J 2006; 70: 21 - 27)

Corresponding author

Register with J-STAGE for free!