In this episode, I’ll discuss the performance of lidocaine vs. amiodarone for refractory ventricular fibrillation or tachycardia in in-hospital cardiac arrest.
Current resuscitation guidelines recommend the use of either amiodarone or lidocaine for refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT). To date, this recommendation has been primarily based on out-of-hospital cardiac arrest evidence. A group of authors sought to determine whether the equivalence of these two medications held up for in-hospital cardiac arrest patients. To this end they published a retrospective analysis in the journal Chest.
The study analyzed over 600 adults with refractory VF/pVT who received lidocaine or amiodarone drawn from 40 hospitals in China.
The primary outcome was survival to hospital discharge or 30 days. Secondary outcomes included sustained return of spontaneous circulation (ROSC) and favorable neurological outcome at discharge or 30 days.
Unadjusted outcomes were similar between groups with survival at 20.1% vs. 23.5%, sustained ROSC at 47.9% vs. 51.6%, and favorable neurological status at 17.0% vs. 21.0%.
After applying multivariable adjustment, there were still no significant differences observed for survival or any outcomes. This finding persisted even when exploratory subgroup analysis was performed.
The authors concluded:
To our knowledge, this is the first study to compare lidocaine and amiodarone specifically in a rigorously adjudicated cohort of adult refractory VF/pVT IHCA patients from a national, multicenter prospective registry. We observed no significant differences in outcomes between the two agents, providing real-world evidence that supports guideline recommendations allowing either antiarrhythmic drug during resuscitation.
In my experience, clinicians have their preferred antiarrhythmic to use during in-hospital cardiac arrests and they never change which one the use first. It is good to know that from an outcome-based perspective, it doesn’t seem to matter which medication is chosen for this indication.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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