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 Raghavendran; Robert 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; John Daniels; Melike Cengiz; Murat Yilmaz; Remzi Iscimen; David Kaufman; Annette Esper; Greg Martin; Ruxana Sadikot; Ivor Douglas; Jonathan Sevransky

doi:10.1016/j.jcrc.2011.10.009

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, John Daniels, Melike Cengiz, Murat Yilmaz, Remzi Iscimen, David Kaufman, Annette Esper, Greg Martin, Ruxana Sadikot, Ivor Douglas, Jonathan Sevransky

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

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 language	English (US)
Pages (from-to)	447-453
Number of pages	7
Journal	Journal of Critical Care
Volume	27
Issue number	5
DOIs	https://doi.org/10.1016/j.jcrc.2011.10.009
State	Published - Oct 1 2012
Externally published	Yes

Keywords

Acute lung injury
Acute respiratory distress syndrome
Amiodarone

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

Access to Document

10.1016/j.jcrc.2011.10.009

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

Karnatovskaia, LV, Festic, E, Gajic, O, Carter, RE, Lee, AS, Ahmed, A, Gajic, O, Malinchoc, M, Kor, DJ, Afessa, B, Cartin-Ceba, R, Dabbagh, O, Nagam, N, Patel, S, Karo, A, Hess, B, Park, PK, Harris, J, Napolitano, L, Raghavendran, K, Hyzy, RC, Blum, J, Dean, C, Adesanya, A, Hosur, S, Enoh, V, Chang, SY, Patrawalla, A, Elie, M, Hou, PC, Barry, JM, Shempp, I, Malhotra, A, Frendl, GY, Anderson, H, Tchorz, K, McCarthy, MC, Uddin, D, Hoth, JJ, Yoza, B, Mikkelsen, M, Christie, JD, Gaieski, DF, Lanken, P, Meyer, N, Shah, C, Gentile, NT, Stevenson, K, Freeman, B, Srinivasan, S, Gong, MN, Talmor, D, Bender, SP, Garcia, M, Bajwa, E, Malhotra, A, Thompson, BT, Christiani, DC, Watkins, TR, Deem, S, Treggiari, M, Festic, E, Daniels, J, Cengiz, M, Yilmaz, M, Iscimen, R, Kaufman, D, Esper, A, Martin, G, Sadikot, R, Douglas, I & Sevransky, J 2012, 'Prehospital amiodarone may increase the incidence of acute respiratory distress syndrome among patients at risk', Journal of Critical Care, vol. 27, no. 5, pp. 447-453. https://doi.org/10.1016/j.jcrc.2011.10.009

@article{c4392d6cc58c49eb91e0cb8b2348bd86,

title = "Prehospital amiodarone may increase the incidence of acute respiratory distress syndrome among patients at risk",

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.",

keywords = "Acute lung injury, Acute respiratory distress syndrome, Amiodarone",

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

note = "Funding Information: The following are the USCIITG-LIPS1 participating centers and corresponding investigators: Mayo Clinic, Rochester, Minn: Adil Ahmed, MD; Ognjen Gajic, MD; Michael Malinchoc, MS; Daryl J. Kor, MD; Bekele Afessa, MD; Rodrigo Cartin-Ceba, MD; Departments of Internal Medicine, Pulmonary and Critical Care Medicine, Health Sciences Research, and Anesthesiology University of Missouri, Columbia: Ousama Dabbagh, MD, MSPH, Associate Professor of Clinical Medicine; Nivedita Nagam, MD; Shilpa Patel, MD; Ammar Karo and Brian Hess University of Michigan, Ann Arbor: Pauline K. Park, MD, FACS, FCCS, Codirector, Surgical Intensive Care Unit, Associate Professor, Surgery; Julie Harris, Clinical Research Coordinator; Lena Napolitano, MD; Krishnan Raghavendran, MBBS; Robert C. Hyzy, MD; James Blum, MD; Christy Dean University of Texas Southwestern Medical Center in Dallas, Tex: Adebola Adesanya, MD; Srikanth Hosur, MD; Victor Enoh, MD; Department of Anesthesiology, Division of Critical Care Medicine University of Medicine and Dentistry of New Jersey: Steven Y. Chang, PhD, MD, Assistant Professor, MICU Director, Pulmonary and Critical Care Medicine; Amee Patrawalla, MD, MPH; Marie Elie, MD Brigham and Women's Hospital: Peter C. Hou, MD; Jonathan M. Barry, BA; Ian Shempp, BS; Atul Malhotra, MD; Gyorgy Frendl, MD, PhD; Departments of Emergency Medicine, Surgery, Internal Medicine and Anesthesiology Perioperative and Pain Medicine, Division of Burn, Trauma, and Surgical Critical Care Wright State University Boonshoft School of Medicine and Miami Valley Hospital: Harry Anderson III, MD, Professor of Surgery; Kathryn Tchorz, MD, Associate Professor of Surgery; Mary C. McCarthy, MD, Professor of Surgery; David Uddin, PhD, DABCC, CIP, Director of Research Wake Forest University Health Sciences, Winston-Salem, NC: James Jason Hoth, MD, Assistant Professor of Surgery; Barbara Yoza, PhD, Study Coordinator University of Pennsylvania: Mark Mikkelsen, MD, MSCE, Assistant Professor of Medicine, Pulmonary, Allergy and Critical Care Division; Jason D. Christie, MD; David F. Gaieski, MD; Paul Lanken, MD; Nuala Meyer, MD; Chirag Shah, MD Temple University School of Medicine: Nina T. Gentile, MD, Associate Professor and Director, Clinical Research; Karen Stevenson, MD; Brent Freeman, BS, Research Coordinator; Sujatha Srinivasan, MD, Department of Emergency Medicine Mount Sinai School of Medicine: Michelle Ng Gong, MD, MS, Assistant Professor, Pulmonary, Critical Care and Sleep Medicine, Department of Medicine Beth Israel Deaconess Medical Center, Boston, Mass: Daniel Talmor, MD, Director of Anesthesia and Critical Care, Associate Professor of Anesthesia, Harvard Medical School; Stephen Patrick Bender, MD; Mauricio Garcia, MD Massachusetts General Hospital Harvard Medical School: Ednan Bajwa, MD, MPH, Instructor in Medicine; Atul Malhotra, MD, Assistant Professor; Boyd Taylor Thompson, MD, Associate Professor; David C. Christiani, MD, MPH, Professor University of Washington, Harborview: Timothy R. Watkins, MD, Acting Instructor, Department of Medicine, Division of Pulmonary and Critical Care Medicine; Steven Deem, MD; Miriam Treggiari, MD, MPH Mayo Clinic Jacksonville: Emir Festic, MD; Augustine Lee, MD; John Daniels, MD Akdeniz University, Antalyia, Turkey: Melike Cengiz, MD, PhD; Murat Yilmaz, MD Uludag University, Bursa, Turkey: Remzi Iscimen, MD Bridgeport Hospital Yale New Haven Health: David Kaufman, MD, Section Chief, Pulmonary, Critical Care and Sleep Medicine, Medical Director, Respiratory Therapy Emory University: Annette Esper, MD; Greg Martin, MD University of Illinois at Chicago: Ruxana Sadikot, MD, MRCP University of Colorado: Ivor Douglas, MD Johns Hopkins University: Jonathan Sevransky, MD, MHS, Assistant Professor of Medicine, Medical Director, JHBMC MICU We would also like to acknowledge the help and support of Rob Taylor (Vanderbilt University, Nashville, Tex) and Joseph J. Wick (Mayo Clinic) for the availability and maintenance of REDcap database. ",

year = "2012",

month = oct,

day = "1",

doi = "10.1016/j.jcrc.2011.10.009",

language = "English (US)",

volume = "27",

pages = "447--453",

journal = "Journal of Critical Care",

issn = "0883-9441",

publisher = "Elsevier BV",

number = "5",

}

TY - JOUR

T1 - Prehospital amiodarone may increase the incidence of acute respiratory distress syndrome among patients at risk

AU - Karnatovskaia, Lioudmila V.

AU - Festic, Emir

AU - Gajic, Ognjen

AU - Carter, Rickey E.

AU - Lee, Augustine S.

AU - Ahmed, Adil

AU - Gajic, Ognjen

AU - Malinchoc, Michael

AU - Kor, Daryl J.

AU - Afessa, Bekele

AU - Cartin-Ceba, Rodrigo

AU - Dabbagh, Ousama

AU - Nagam, Nivedita

AU - Patel, Shilpa

AU - Karo, Ammar

AU - Hess, Brian

AU - Park, Pauline K.

AU - Harris, Julie

AU - Napolitano, Lena

AU - Raghavendran, Krishnan

AU - Hyzy, Robert C.

AU - Blum, James

AU - Dean, Christy

AU - Adesanya, Adebola

AU - Hosur, Srikanth

AU - Enoh, Victor

AU - Chang, Steven Y.

AU - Patrawalla, Amee

AU - Elie, Marie

AU - Hou, Peter C.

AU - Barry, Jonathan M.

AU - Shempp, Ian

AU - Malhotra, Atul

AU - Frendl, Gyorgy Y.

AU - Anderson, Harry

AU - Tchorz, Kathryn

AU - McCarthy, Mary C.

AU - Uddin, David

AU - Hoth, James Jason

AU - Yoza, Barbara

AU - Mikkelsen, Mark

AU - Christie, Jason D.

AU - Gaieski, David F.

AU - Lanken, Paul

AU - Meyer, Nuala

AU - Shah, Chirag

AU - Gentile, Nina T.

AU - Stevenson, Karen

AU - Freeman, Brent

AU - Srinivasan, Sujatha

AU - Gong, Michelle Ng

AU - Talmor, Daniel

AU - Bender, Stephen Patrick

AU - Garcia, Mauricio

AU - Bajwa, Ednan

AU - Malhotra, Atul

AU - Thompson, Boyd Taylor

AU - Christiani, David C.

AU - Watkins, Timothy R.

AU - Deem, Steven

AU - Treggiari, Miriam

AU - Festic, Emir

AU - Daniels, John

AU - Cengiz, Melike

AU - Yilmaz, Murat

AU - Iscimen, Remzi

AU - Kaufman, David

AU - Esper, Annette

AU - Martin, Greg

AU - Sadikot, Ruxana

AU - Douglas, Ivor

AU - Sevransky, Jonathan

N1 - Funding Information: The following are the USCIITG-LIPS1 participating centers and corresponding investigators: Mayo Clinic, Rochester, Minn: Adil Ahmed, MD; Ognjen Gajic, MD; Michael Malinchoc, MS; Daryl J. Kor, MD; Bekele Afessa, MD; Rodrigo Cartin-Ceba, MD; Departments of Internal Medicine, Pulmonary and Critical Care Medicine, Health Sciences Research, and Anesthesiology University of Missouri, Columbia: Ousama Dabbagh, MD, MSPH, Associate Professor of Clinical Medicine; Nivedita Nagam, MD; Shilpa Patel, MD; Ammar Karo and Brian Hess University of Michigan, Ann Arbor: Pauline K. Park, MD, FACS, FCCS, Codirector, Surgical Intensive Care Unit, Associate Professor, Surgery; Julie Harris, Clinical Research Coordinator; Lena Napolitano, MD; Krishnan Raghavendran, MBBS; Robert C. Hyzy, MD; James Blum, MD; Christy Dean University of Texas Southwestern Medical Center in Dallas, Tex: Adebola Adesanya, MD; Srikanth Hosur, MD; Victor Enoh, MD; Department of Anesthesiology, Division of Critical Care Medicine University of Medicine and Dentistry of New Jersey: Steven Y. Chang, PhD, MD, Assistant Professor, MICU Director, Pulmonary and Critical Care Medicine; Amee Patrawalla, MD, MPH; Marie Elie, MD Brigham and Women's Hospital: Peter C. Hou, MD; Jonathan M. Barry, BA; Ian Shempp, BS; Atul Malhotra, MD; Gyorgy Frendl, MD, PhD; Departments of Emergency Medicine, Surgery, Internal Medicine and Anesthesiology Perioperative and Pain Medicine, Division of Burn, Trauma, and Surgical Critical Care Wright State University Boonshoft School of Medicine and Miami Valley Hospital: Harry Anderson III, MD, Professor of Surgery; Kathryn Tchorz, MD, Associate Professor of Surgery; Mary C. McCarthy, MD, Professor of Surgery; David Uddin, PhD, DABCC, CIP, Director of Research Wake Forest University Health Sciences, Winston-Salem, NC: James Jason Hoth, MD, Assistant Professor of Surgery; Barbara Yoza, PhD, Study Coordinator University of Pennsylvania: Mark Mikkelsen, MD, MSCE, Assistant Professor of Medicine, Pulmonary, Allergy and Critical Care Division; Jason D. Christie, MD; David F. Gaieski, MD; Paul Lanken, MD; Nuala Meyer, MD; Chirag Shah, MD Temple University School of Medicine: Nina T. Gentile, MD, Associate Professor and Director, Clinical Research; Karen Stevenson, MD; Brent Freeman, BS, Research Coordinator; Sujatha Srinivasan, MD, Department of Emergency Medicine Mount Sinai School of Medicine: Michelle Ng Gong, MD, MS, Assistant Professor, Pulmonary, Critical Care and Sleep Medicine, Department of Medicine Beth Israel Deaconess Medical Center, Boston, Mass: Daniel Talmor, MD, Director of Anesthesia and Critical Care, Associate Professor of Anesthesia, Harvard Medical School; Stephen Patrick Bender, MD; Mauricio Garcia, MD Massachusetts General Hospital Harvard Medical School: Ednan Bajwa, MD, MPH, Instructor in Medicine; Atul Malhotra, MD, Assistant Professor; Boyd Taylor Thompson, MD, Associate Professor; David C. Christiani, MD, MPH, Professor University of Washington, Harborview: Timothy R. Watkins, MD, Acting Instructor, Department of Medicine, Division of Pulmonary and Critical Care Medicine; Steven Deem, MD; Miriam Treggiari, MD, MPH Mayo Clinic Jacksonville: Emir Festic, MD; Augustine Lee, MD; John Daniels, MD Akdeniz University, Antalyia, Turkey: Melike Cengiz, MD, PhD; Murat Yilmaz, MD Uludag University, Bursa, Turkey: Remzi Iscimen, MD Bridgeport Hospital Yale New Haven Health: David Kaufman, MD, Section Chief, Pulmonary, Critical Care and Sleep Medicine, Medical Director, Respiratory Therapy Emory University: Annette Esper, MD; Greg Martin, MD University of Illinois at Chicago: Ruxana Sadikot, MD, MRCP University of Colorado: Ivor Douglas, MD Johns Hopkins University: Jonathan Sevransky, MD, MHS, Assistant Professor of Medicine, Medical Director, JHBMC MICU We would also like to acknowledge the help and support of Rob Taylor (Vanderbilt University, Nashville, Tex) and Joseph J. Wick (Mayo Clinic) for the availability and maintenance of REDcap database.

PY - 2012/10/1

Y1 - 2012/10/1

N2 - 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.

AB - 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.

KW - Acute lung injury

KW - Acute respiratory distress syndrome

KW - Amiodarone

UR - http://www.scopus.com/inward/record.url?scp=84867328337&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867328337&partnerID=8YFLogxK

U2 - 10.1016/j.jcrc.2011.10.009

DO - 10.1016/j.jcrc.2011.10.009

M3 - Article

C2 - 22226422

AN - SCOPUS:84867328337

SN - 0883-9441

VL - 27

SP - 447

EP - 453

JO - Journal of Critical Care

JF - Journal of Critical Care

IS - 5

ER -

Prehospital amiodarone may increase the incidence of acute respiratory distress syndrome among patients at risk

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