Antipsychotic drugs are associated with pulseless electrical activity: The Oregon Sudden Unexpected Death Study

BACKGROUND There has been a paradigm shift in the manifestation of sudden cardiac arrest (SCA), with steadily decreasing rates of ventricular fibrillation/tachycardia (VF/VT) and a significant increase in the proportion of pulseless electrical activity (PEA) and asystole. OBJECTIVE Since PEA is marked by failure of myocardial contractility, we evaluated the potential rote of drugs that affect cardiac contractility in the pathophysiology of human PEA. METHODS Subjects with out-of-hospital SCA (aged >= 18 years) who underwent attempted resuscitation were evaluated in the ongoing Oregon Sudden Unexpected Death Study (2002-2009). Specific classes of medications with either negative or positive cardiac inotropic effects were evaluated for association with occurrence of PEA vs VF/VT by using Pearson chi(2) tests and Logistic regression. RESULTS PEA cases (n = 309) were order than VF/VT cases (n = 509; 68 +/- 14 years vs 64 +/- 15 years; P < .0001) and were more likely to be women (39% vs 25%; P < .0001). In a Logistic regression mode L adjusting for age, sex, comorbidities, disease burden, and resuscitation variables, antipsychotic drugs (odds ratio 2.40; 95% confidence interval 1.26-4.53) were significant predictors of PEA vs VF/VT. Conversely, use of digoxin was associated with the occurrence of VF/VT (P < .0001). CONCLUSIONS When drugs modifying myocardial contractility were evaluated in a comprehensive analysis of patients who suffered SCA, use of antipsychotic agents was a significant and independent predictor of manifestation with PEA.