Comparative Effectiveness of Amiodarone and Lidocaine for the Treatment of In-Hospital Cardiac Arrest.

BACKGROUND: American Heart Association Advanced Cardiac Life Support (ACLS) guidelines support the use of either amiodarone or lidocaine for cardiac arrest caused by ventricular tachycardia or ventricular fibrillation (VT/VF) based on studies of out-of-hospital cardiac arrest. Studies comparing amiodarone and lidocaine in adult populations with in-hospital VT/VF arrest are lacking. RESEARCH QUESTION: Does treatment with amiodarone vs lidocaine therapy have differential associations with outcomes among adult patients with in-hospital cardiac arrest from VT/VF? STUDY DESIGN AND METHODS: This retrospective cohort study of adult patients receiving amiodarone or lidocaine for VT/VF in-hospital cardiac arrest refractory to CPR and defibrillation between January 1, 2000, and December 31, 2014, was conducted within American Heart Association Get With the Guidelines-Resuscitation (GWTG-R) participating hospitals. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes were 24 h survival, survival to hospital discharge, and favorable neurologic outcome. RESULTS: Among 14,630 patients with in-hospital VT/VF arrest, 68.7% (n = 10,058) were treated with amiodarone and 31.3% (n = 4,572) with lidocaine. When all covariates were statistically controlled, compared with amiodarone, lidocaine was associated with statistically significantly higher odds of the following: (1) ROSC (adjusted OR [AOR], 1.15, P = .01; average marginal effect [AME], 2.3; 95% CI, 0.5 to 4.2); (2) 24 h survival (AOR, 1.16; P = 004; AME, 3.0; 95% CI, 0.9 to 5.1); (3) survival to discharge (AOR, 1.19; P < .001; AME, 3.3; 95% CI, 1.5 to 5.2); and (4) favorable neurologic outcome at hospital discharge (AOR, 1.18; P < .001; AME, 3.1; 95% CI, 1.3 to 4.9). Results using propensity score methods were similar to those from multivariable logistic regression analyses. INTERPRETATION: Compared with amiodarone, lidocaine therapy among adult patients with in-hospital cardiac arrest from VT/VF was associated with statistically significantly higher rates of ROSC, 24 h survival, survival to hospital discharge, and favorable neurologic outcome.

Prognostic importance of marital quality for survival of congestive heart failure.

Mounting evidence indicates that social support is associated with better outcomes of cardiovascular disease and reduced all-cause mortality. Much less is known about the specific contribution of marital functioning to these outcomes, and the potential prognostic significance of marital quality for congestive heart failure (CHF) has not been explored. Interview and observational measures of marital quality obtained from 189 patients with CHF (139 men and 50 women) and their spouses were examined as predictors of patient survival up to 48 months after assessment and compared with prediction based on illness severity (New York Heart Association [NYHA] class). Four-year survival rates were 52.5% and 68% for male patients and female patients, respectively. In Cox regression analyses, a composite measure of marital quality predicted 4-year survival as well as the patient's concurrent NYHA class did (both p <0.001). Adjusting for CHF severity did not diminish the prognostic significance of marital functioning, and prediction of survival from marital quality appeared stronger for female than for male patients. Thus, when marital quality and NYHA class are considered jointly, they both make independent, statistically significant contributions to the prediction of patient mortality.

Milk yield and composition in the punare Thrichomys apereoides.

1. Per cent fat composition of the milk was unusually high, ranging from 30.2 +/- 0.8% on day 2, to 21.0 +/- 1.0% on day 21. 2. Per cent protein changed significantly over time, ranging from 11.9 +/- 0.6% to 17.4 +/- 0.9%. 3. Lactose content was low, and decreased significantly over time, from 4.62 +/- 0.1% to 2.65 +/- 0.1%. 4. Milk production peaked at day 14 and ceased by day 35. 5. The unusual milk composition of this tropical rodent, is one of several adaptations correlated with reproduction in a xeric environment.

Variability in milk composition of the domestic ferret (Mustela putorius).

Ferret milk composition was analyzed among individuals, over time, and across teat pairs. Females differed in fat, protein, and lactose concentrations. Protein and fat concentrations varied over the course of lactation. Lactose was the only measured component which differed across teat pairs.

Body temperature, heart rate and oxygen consumption of normothermic and heterothermic western jumping mice (Zapus princeps).

1. Heart rates and oxygen consumption were measured for normothermic, hibernating, and arousing Zapus princeps. 2. Rectal and oral body temperature were monitored and differential rates of rewarming of the body were recorded. 3. Lengths of periodic arousals differ in two stages of hibernation; days 50-80 arousal durations were 12 hr, 43 min while days 140-210 were 10 hr, 28 min. 4. Total energy budget of hibernation was calculated for a 295 day hibernation cycle based on the utilization of 18,020 cc of oxygen for that period. The calculated utilization of fat would be 8.97 g while the observed use was 9.5-11.1 g.