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Amiodarone vs Lidocaine for In-Hospital Cardiac Arrest

January 6, 2023

Written by Megan Hilbert

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For in-hospital ventricular fibrillation/ventricular tachycardia (VF/VT) arrest (IHCA), lidocaine may have more favorable outcomes compared to amiodarone.

Why does this matter?
The 2018 American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) guidelines are formulated from out-of-hospital cardiac arrest data. With over 350,000 sudden cardiac deaths a year, with nearly half occurring in the hospital, are the current guidelines optimized for IHCA patients?

Unstable gets the cable…and anti-arrhythmic
This was a retrospective observational cohort study completed using the AHA’s Get with the Guidelines – Resuscitation (GWTG-R) inpatient registry. Specifically, they looked at 14,630 adult patients who had suffered an in-hospital cardiac arrest (VT/VF) who received defibrillation and either lidocaine or amiodarone. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes included 24-hour survival, survival to hospital discharge, and favorable neurologic outcome (yay for a patient-centered outcome!).

Data were evaluated using propensity score methods and reported in average marginal effect (AME), which shows the risk difference between two groups. Given that 68.7% of patients received amiodarone and 31.3% received lidocaine, there were significant group size differences. When fully adjusted for confounders, lidocaine was shown to have, “statistically significantly higher rates of ROSC (AME=2.3%), 24-hour survival (AME=3.0%), survival to discharge (AME=3.3%), and favorable neurologic survival (AME=3.1%).”

There are limitations to this study, specifically that it was observational and additional information regarding the arrest (i.e. precipitating factors, duration, dosage of medication administered) was not evaluated. And while differences exist in hospital protocols which may ultimately guide selection of medication, this study shows that it may be smart to pause (not compressions, just our thought process) and consider lidocaine before amiodarone.

Comparative Effectiveness of Amiodarone and Lidocaine for Treatment of In-Hospital Cardiac Arrest (IHCA). Chest. 2022 Nov 1;S0012-3692(22)04039-9. doi: 10.1016/j.chest.2022.10.024. Online ahead of print.

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