PEDIATRIC USE OF INTRAVENOUS AMIODARONE - EFFICACY AND SAFETY IN CRITICALLY ILL PATIENTS FROM A MULTICENTER PROTOCOL

Objective. The purpose of this study was to analyze the efficacy and s afety of intravenous amiodarone in young patients with critical, drug resistant arrhythmias. Background. Intravenous amiodarone has been inv estigated in adults since the early 1980s. Experience with the drug in young patients is limited. A larger pediatric study group was necessa ry to provide responsible guidelines for the drug's use before its mar ket release. Methods. Eight centers obtained institutional approval of a standardized protocol. Other centers were approved on a compassiona te use basis after contacting the primary investigator (J.C.P.). Resul ts. Forty patients were enrolled. Standard management in all failed. M any patients had early postoperative tachyarrhythmias (25 of 40), with early successful treatment in 21 (84%) of 25. Twelve patients had ven tricular tachyarrhythmias: seven had successful therapy, and six died, none related to the drug. Eleven patients had atrial tachyarrhythmias : 10 of 11 had immediate success, but 3 later died. Fourteen patients had junctional ectopic tachycardia, which was treated with success (si nus rhythm or slowing, allowing pacing) in 13 of 14, with no deaths. T hree other patients had supraventricular tachycardias, with success in two and no deaths, The average loading dose was 6.3 mg/kg body weight , and 50% of patients required a continuous infusion. Four patients ha d mild hypotension during the amiodarone bolus. One postoperative pati ent experienced bradycardia requiring temporary pacing. There were no proarrhythmic effects. Deaths (9 [23%] of 40) were not attributed to a miodarone. Conclusions. Intravenous amiodarone is safe and effective i n most young patients with critical tachyarrhythmia. Intravenous amiod arone can be lifesaving, particularly for postoperative junctional ect opic tachycardia, when standard therapy is ineffective.