PACU Literature Review #17

Wagner D, Kronick SL, Nawer H, Cranford JA, Bradley SM, Neumar RW. Comparative Effectiveness of Amiodarone and Lidocaine for the Treatment of: In-Hospital Cardiac Arrest. Chest. Published online November 2, 2022:S0012-3692(22)04039-9.

PMID: 336332663

---

BACKGROUND

• ACLS guidelines support the use of either amiodarone or lidocaine for cardiac arrest caused by ventricular fibrillation or ventricular tachycardia based on studies of out-of-hospital cardiac arrest. Studies comparing the two in in-hospital cardiac arrest (IHCA) are lacking

STUDY OBJECTIVE

• To determine if treatment with amiodarone vs lidocaine has differential associations with outcomes among adults with IHCA

STUDY DESIGN

• Retrospective cohort study with data sourced from the American Heart Association’s Get With the Guidelines-Resuscitation inpatient registry, a national, multicenter, prospective registry

Study Intervention & Comparison

• Amiodarone vs lidocaine during cardiac arrest
  • Dosing not specified, presumed to be dosed according to ACLS

Results

• Primary Outcome
  • Lidocaine associated with significantly higher odds of return of spontaneous circulation (aOR 1.15, p=0.01)
• Secondary Outcomes
  • Lidocaine associated with significantly higher odds of:
    • 24-hour survival postarrest (aOR 1.16, p=0.004)
    • Survival to hospital discharge (aOR 1.19, p<0.001)
    • Favorable neurologic outcome at discharge (aOR 1.18, p<0.001)

*Outcomes reported above are statistically controlled for all covariates

Summary

• Compared with amiodarone, lidocaine was associated with significantly higher rates of ROSC, 24h survival, survival to hospital discharge, and favorable neurologic outcome among adult patients with in-hospital cardiac arrest from ventricular fibrillation or ventricular tachycardia.

---

Additional Readings

• Kudenchuk PJ, Cobb LA, Copass MK, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med. 1999;341(12):871-878.
• Dorian P, Cass D, Schwartz B, Cooper R, Gelaznkas R, Barr A. Amiodarone as compared with lidocaine for shock- resistant ventricular fibrillation. N Engl J Med. 2002;346(12):884-890.
• Kudenchuk PJ, Brown SP, Daya M, et al. Amiodarone, lidocaine, or placebo in out- of-hospital cardiac arrest. N Engl J Med. 2016;374(18):1711-1722.

---