Written by Jacob Altholz
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Lidocaine use during pre-hospital resuscitation from ventricular fibrillation or ventricular tachycardia (VF/VT) resistant to defibrillation, when compared to amiodarone, was associated with higher rates of ROSC, fewer post-drug shocks, and greater odds of survival to discharge in this observational study.
Amiodarone abates… lidocaine lives?
Given the numerous and sometimes conflicting studies comparing amiodarone and lidocaine in VF/VT arrests, this observational study took data from the ESO Data Collaborative and retrospectively compared the use of lidocaine vs. amiodarone. Using a target trial emulation strategy. They excluded patients who were thought to potentially confound the investigation, such as extremes of age, those from nursing homes, or those who arrested in front of EMS.
Those receiving lidocaine were more likely to achieve pre-hospital ROSC compared with amiodarone (36.0% vs 30.4%, p = <0.001). These patients were also less likely to require subsequent defibrillators or pacing or to experience bradycardia or hypotension. More patients in the lidocaine group survived to hospital discharge (35.1% vs. 25.7%, p = 0.001).
The study acknowledges the usual limitations to retrospective observational studies and notes that the vast majority of patients received amiodarone (87.2%), suggesting that the use of lidocaine might be correlated with other practice pattern deviations, especially given sub-analyses showing that among patients who had VF/VT but did not receive any medication, those resuscitated by lidocaine-predominant agencies were less likely to achieve ROSC. The study also acknowledges that pre-hospital termination of resuscitation becoming the norm may potentially skew these data sets in unforeseen ways.
How does this change my practice?
Given the decades-old debate of amiodarone vs. lidocaine and conflicting evidence in other studies, the study at the very least lends credence to lidocaine’s continued use in some areas, especially given that amiodarone has nearly supplanted the medication. I’m particularly interested in seeing what further studies develop given the reported mortality benefit.
Source
A retrospective ‘target trial emulation’ comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. Resuscitation. 2025 Mar;208:110515. doi: 10.1016/j.resuscitation.2025.110515. Epub 2025 Jan 23. PMID: 39863130
