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Do Antiarrhythmic Drugs Help In Cardiac Arrest?

October 29, 2018

Written by Clay Smith

Spoon Feed
When considering 14 RCTs on use of antiarrhythmic drugs for shockable cardiac arrest, there was no benefit for survival to discharge or survival with good neurological outcome. Lidocaine improved ROSC vs placebo.

Why does this matter?
We have been slowly realizing that antiarrhythmic drugs don’t seem to help much in cardiac arrest. More and more RCTs find the same thing – they don’t work better than placebo. This was a systematic review of all these studies in anticipation of the new ILCOR recommendations.

Hugs not drugs
This was a meta-analysis of 14 RCTs and 18 observational studies (only one of which was in pediatric patients) regarding use of antiarrhythmics for shockable cardiac arrest. Focusing on the 14 RCTs, there was no difference in the outcomes that mattered, namely survival to discharge or discharge with good neurological outcome. There was a single observational study in 889 children, “comparing amiodarone, lidocaine, amiodarone plus lidocaine, and standard care for in-hospital pediatric cardiac arrest and a shockable rhythm. The results showed no differences in effect for the outcome of survival to hospital discharge.” Lidocaine improved ROSC vs placebo. If these drugs don’t help, why are they still recommended in the ACLS algorithm? One wonders…

Another Spoonful
LITFL has an excellent older post on this.

Effectiveness of antiarrhythmic drugs for shockable cardiac arrest: A systematic review. Resuscitation. 2018 Sep 1;132:63-72. doi: 10.1016/j.resuscitation.2018.08.025. [Epub ahead of print]

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What are your thoughts?