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Clin Exp Emerg Med > Accepted Articles
doi: https://doi.org/10.15441/ceem.23.158    [Accepted]
A multicenter, randomized, double-blinded, placebo-controlled trial of amantadine to stimulate awakening in comatose patients resuscitated from cardiac arrest
Patrick J. Coppler1 , David J. Gagnon2 , Katharyn L. Flickinger1 , Jonathan Elmer1,3,4 , Clifton W. Callaway1 , Francis X. Guyette1 , Ankur Doshi1 , Alexis Steinberg1,3,4 , Cameron Dezfulian5 , Ari L. Moskowitz6 , Michael Donnino7 , Teresa L May2 , David B Seder2 , Jon C. Rittenberger8
1Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
2Department of Critical Care Services, Maine Medical Center, Portland, ME, USA
3Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
4Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
5Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
6Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
7Department of Medicine, Beth Israel Deaconess, Boston, MA, USA
8Geisinger Commonwealth School of Medicine, Scranton, PA, USA
Correspondence  Jon C. Rittenberger Email: jon.rittenberger@guthrie.org
Received: November 8, 2023. Revised: December 21, 2023.  Accepted: December 22, 2023. Published online: January 29, 2024.
We hypothesized that the administration of amantadine would increase awakening of comatose patients resuscitated from cardiac arrest.
We performed a prospective, randomized, controlled pilot trial, randomizing subjects to amantadine 100 mg twice daily or placebo for up to 7 days. The study drug was administered between 72 and 120 hours after resuscitation and patients with absent N20 cortical responses, early cerebral edema, or ongoing malignant electroencephalography patterns were excluded. Our primary outcome was awakening, defined as following two-step commands, within 28 days of cardiac arrest. Secondary outcomes included length of stay, awakening, time to awakening, and neurologic outcome measured by Cerebral Performance Category at hospital discharge. We compared the proportion of subjects awakening and hospital survival using Fisher exact tests and time to awakening and hospital length of stay using Wilcoxon rank sum tests.
After 2 years, we stopped the study due to slow enrollment and lapse of funding. We enrolled 14 subjects (12% of goal enrollment), seven in the amantadine group and seven in the placebo group. The proportion of patients who awakened within 28 days after cardiac arrest did not differ between amantadine (n=2, 28.6%) and placebo groups (n=3, 42.9%; P=1.00). There were no differences in secondary outcomes. Study medication was stopped in three subjects (21.4%). Adverse events included a recurrence of seizures (n=2; 14.3%), both of which occurred in the placebo group.
We could not determine the effect of amantadine on awakening in comatose survivors of cardiac arrest due to small sample size.
Keywords: Heart arrest; Coma; Hypoxic-ischemic brain injury; Amantadine; Neurostimulant
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