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Lidocaine vs Amiodarone for PALS?

February 20, 2020

Written by Clay Smith

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There was no difference in any clinical outcome in pediatric patients with shockable rhythm with lidocaine vs amiodarone.

Why does this matter?
Either lidocaine or amiodarone is acceptable in PALS for shock-refractory v-fib or pulseless v-tach. Is one preferred over another? Pick one…
This was a propensity matching study based on a pediatric in-hospital arrest registry over an 18 year period with shock-refractory v-fib or pulseless v-tach. They matched 90 patients in each group, with the only difference being administration of lidocaine or amiodarone. I won’t put all the risk ratios or 95%CI, as they were almost all near 1. There was no difference in ROSC, 24-hour survival, survival to discharge, or survival with favorable neurological outcome comparing lidocaine to amiodarone. Again, despite this being a large registry with 18 years of data, the total number of patients they were able to include was small. Although propensity matching helps, there is always danger of confounding. However, in this study, it looks like it really doesn’t matter which agent you choose for the next round of PALS if defibrillation fails.

Lidocaine versus Amiodarone for Pediatric In-Hospital Cardiac Arrest: An Observational Study. Resuscitation. 2020 Jan 16. pii: S0300-9572(20)30013-7. doi: 10.1016/j.resuscitation.2019.12.033. [Epub ahead of print]

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What are your thoughts?