• Takashi Tagami, Hiroki Matsui, Saori Ishinokami, Masao Oyanagi, Akiko Kitahashi, Reo Fukuda, Kyoko Unemoto, Kiyohide Fushimi, and Hideo Yasunaga.
• Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan. Electronic address: t-tagami@nms.ac.jp.
• Resuscitation. 2016 Dec 1; 109: 127-132.

BackgroundWe evaluated the association between nifekalant or amiodarone on hospital admission and in-hospital mortality for cardiac arrest patients with persistent ventricular fibrillation on hospital arrival.MethodsThis was a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We identified 2961 patients who suffered cardiogenic out-of-hospital cardiac arrest and who had ventricular fibrillation on hospital arrival between July 2007 and March 2013. Patients were categorized into amiodarone (n=2353) and nifekalant (n=608) groups, from which 525 propensity score-matched pairs were generated.ResultsWe found a significant difference in the admission rate between the nifekalant and amiodarone groups in propensity score-matched groups (75.6% vs. 69.3%, respectively; difference, 6.3%; 95% confidence interval (CI), 0.9-11.7). An analysis using the hospital nifekalant/amiodarone rate as an instrumental variable found that receiving nifekalant was associated with an improved admission rate (22.2%, 95% CI, 11.9-32.4). We found no significant difference in in-hospital mortality between the nifekalant and amiodarone groups (81.5% vs. 82.1%, respectively; difference, -0.6%; 95% CI, -5.2 to 4.1). Instrumental variable analysis showed that receiving nifekalant was not associated with reduced in-hospital mortality (6.2%, 95% CI, -2.4 to 14.8).ConclusionsThis nationwide study suggested no significant in-hospital mortality association between nifekalant and amiodarone for cardiogenic out-of-hospital cardiac arrest patients with ventricular fibrillation/persistent ventricular tachycardia on hospital arrival. Although nifekalant may potentially improve hospital admission rates compared with amiodarone for these patients, further studies are required to confirm our results.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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