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, Adil Ahmed, Ognjen Gajic, Michael Malinchoc, Daryl J. Kor, Bekele Afessa, Rodrigo Cartin-Ceba, Ousama Dabbagh, Nivedita Nagam, Shilpa Patel, Ammar Karo, Brian Hess, Pauline K. Park, Julie Harris, Lena Napolitano, Krishnan RaghavendranRobert C. Hyzy, James Blum, Christy Dean, Adebola Adesanya, Srikanth Hosur, Victor Enoh, Steven Y. Chang, Amee Patrawalla, Marie Elie, Peter C. Hou, Jonathan M. Barry, Ian Shempp, Atul Malhotra, Gyorgy Y. Frendl, Harry Anderson, Kathryn Tchorz, Mary C. McCarthy, David Uddin, James Jason Hoth, Barbara Yoza, Mark Mikkelsen, Jason D. Christie, David F. Gaieski, Paul Lanken, Nuala Meyer, Chirag Shah, Nina T. Gentile, Karen Stevenson, Brent Freeman, Sujatha Srinivasan, Michelle Ng Gong, Daniel Talmor, Stephen Patrick Bender, Mauricio Garcia, Ednan Bajwa, Atul Malhotra, Boyd Taylor Thompson, David C. Christiani, Timothy R. Watkins, Steven Deem, Miriam Treggiari, Emir Festic, Augustine Lee, John Daniels, Melike Cengiz, Murat Yilmaz, Remzi Iscimen, David Kaufman, Annette Esper, Greg Martin, Ruxana Sadikot, Ivor Douglas, Jonathan Sevransky

Research output: Contribution to journalArticle

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Abstract

Purpose: Amiodarone 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. Materials: Adult 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. Results: Forty 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). Conclusions: Prehospital use of amiodarone may independently increase the risk for ARDS in patients who have at least 1 predisposing condition for ALI.

Original languageEnglish (US)
Pages (from-to)447-453
Number of pages7
JournalJournal of Critical Care
Volume27
Issue number5
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

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Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • Amiodarone

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Karnatovskaia, L. V., Festic, E., Gajic, O., Carter, R. E., Lee, A. S., Ahmed, A., Gajic, O., Malinchoc, M., Kor, D. J., Afessa, B., Cartin-Ceba, R., Dabbagh, O., Nagam, N., Patel, S., Karo, A., Hess, B., Park, P. K., Harris, J., Napolitano, L., ... Sevransky, J. (2012). Prehospital amiodarone may increase the incidence of acute respiratory distress syndrome among patients at risk. Journal of Critical Care, 27(5), 447-453. https://doi.org/10.1016/j.jcrc.2011.10.009