Evidence Based Medicine and Clinical Trials of Amiodarone

Evidence Based Medicine and Clinical Trials of Amiodarone IV Sponsored by Doc. MD. com

AHA Evidence-based Guidelines • Step 1: gather the evidence - Credible sources Predetermined criteria (e. g. , human studies only, etc. ) • Step 2: assess quality of evidence - Power of methodology (level 1 -8) - Execution of methodology (excellent, good, fair, poor) - Critical review • Step 3: determine the class recommendation - class I, IIa, IIb, III, indeterminate

Linking AHA Evidence-based Guidelines to ACLS Treatment Recommendations Evidence Quality Recommendation • Level 1: large randomized • Excellent • Good • Fair • Poor • Class I: definite, excellent clinical trials • Level 2: smaller randomized clinical trials • Level 3: prospective, controlled, nonrandomized cohort studies • Level 4: historic, nonrandomized cohort or case-control studies • Level 5: case series, no control group • Level 6: animal or mechanical model • Level 7: extrapolations from existing data; theoretical analyses • Level 8: rational conjecture (common sense); common practice level 1 evidence • Class II: acceptable and useful; no harm Class II a: good supportive evidence Class II b: fair supportive evidence • Class III: not acceptable; may be harmful • Indeterminate: insufficient data

Lidocaine in VF/VT Cardiac Arrest Evidence Analysis Supportive Excellent Quality Good Fair Level of Evidence 1 2 3 Herlitz ’ 97 (1360) Carden ’ 56 (23) Lazzara ’ 73, ’ 78 Borer ’ 76 Spear ’ 72 Harrison ’ 63 (12) MI Trials Current (Lie ’ 74) Practice 4 6 7 5 Neutral/Opposing Excellent Haynes ’ 81 (146) Quality Good Olson ’ 84 (108) Redding ’ 68 (105) Vachiery ’ 90 (18) Chow ’ 86 Anastasiou ’ 94 (16) Babbs ’ 79 Echt ’ 89 Dorian ’ 86 Sadowski ’ 99 (903) Kerber ’ 86 MI Metanalyses Harrison ’ 81 (116) Fair Level of Evidence 1 Van. Walraven ’ 98 (773) Weaver ’ 90 (199) 2 3 8 Alexander ’ 99 (43704) 4 5 6 7 8 Kudenchuk; AHA National Meeting, Dallas, TX, Feb. 3 2000

Lidocaine in VF/VT Cardiac Arrest Supportive Neutral/Opposing • • • One “fair” level 4 One “fair” level 6 Numerous “fair” level 7 One “excellent” level 2 One “good” level 2 One “fair” level 3 One “good” level 6 One “fair” level 8 Two “good” level 4 Seven “good” level 6 Two “good” recent level 7

I. V. Amiodarone in VF/VT Cardiac Arrest Evidence Analysis Excellent Supportive Kudenchuk ’ 99 (504) Quality Good Nalos ’ 91 (22) Schutzenberger ’ 89 (26) Helmy ’ 88 (46) Anastasiou’ 94 (16) Horowitz (5) Fain ’ 87 (12) Morady (15) Rosalion ’ 91 (23) Saksena (9) Klein (13) Drexler (14) Ochl (22) Mooss (35) Kentsch ’ 89 (20) Kowey ’ 98 (228) Fair Level of Evidence 1 2 3 4 5 6 7 8 Neutral/Opposing Excellent Quality Good Zhou ’ 98 (24) Levine ’ 96 (273) Scheinman ’ 95 (342) Fair Level of Evidence 1 2 3 4 5 6 7 8 Kudenchuk; AHA National Meeting, Dallas, TX, Feb. 3 2000

I. V. Amiodarone in VF/VT Cardiac Arrest Supportive Neutral/Opposing • • Two”good” level 2 • One “excellent” level 7 One “excellent” level 1 • Two “good” level 2 • Numerous “fair” level 5 • Two “good” level 6 • One “good” level 7