In this episode, I’ll discuss amiodarone vs lidocaine for in-hospital cardiac arrest.
The ACLS guidelines suggest either amiodarone or lidocaine for in-hospital cardiac arrest that is due to ventricular tachycardia or ventricular fibrillation (VT/VF). However this recommendation has always been based on data from out-of-hospital cardiac arrest studies.
A group of authors recently published a retrospective cohort study attempting to answer whether there is a difference in outcomes when using treatment with amiodarone vs. lidocaine among adult patients with in-hospital cardiac arrest (IHCA) from VT/VF.
Data from over 14,500 patients spanning a 14-year period was collected and analyzed. This patient data was pulled from the American Heart Association Get With the Guidelines-Resuscitation participating hospitals so it represents multiple centers. The primary outcome for the study was the return of spontaneous circulation and the secondary outcomes were 24-hour survival, survival to hospital discharge, and favorable neurological outcome.
In the cohort about two-thirds of the patients received amiodarone and one-third received lidocaine to treat in-hospital VT/VF arrest. After adjustment for covariates, lidocaine was favorable to amiodarone in the primary outcome and all 3 secondary outcomes.
For return of spontaneous circulation, lidocaine had an adjusted odds ratio of 1.15.
For 24-hour survival, lidocaine had an adjusted odds ratio of 1.16.
For survival to hospital discharge, lidocaine had an adjusted odds ratio of 1.19.
For favorable neurological outcome, lidocaine had an adjusted odds ratio of 1.18.
This study represents the only data comparing amiodarone to lidocaine for in-hospital cardiac arrest and due to the nature of the problem it is unlikely that a study using a higher quality methodology will ever be conducted.
While we wait for the AHA to decide whether to update guideline recommendations, there is nothing in the way of clinicians choosing to use lidocaine over amiodarone based on these results since the guidelines currently give lidocaine equal consideration.
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