Clinical question: Are amiodarone and lidocaine associated with different outcomes for the treatment of in-hospital cardiac arrests?
Background: Both amiodarone and lidocaine are recommended in the American Heart Association’s advanced cardiac life support guidelines for the management of ventricular tachycardia/ventricular fibrillation (VT/VF) resulting in cardiac arrest, based on studies looking at out-of-hospital cardiac arrests. However, there have been no studies looking at their use in in-hospital cardiac arrests.
Study design: Retrospective cohort study
Setting: Hospitals participating in American Heart Association Get With the Guidelines-Resuscitation
Synopsis: The retrospective cohort study looked at 14,630 adult patients who experienced CPR and defibrillation refractory cardiac arrest due to VT/VF from January 1, 2000, to December 31, 2014, and received lidocaine or amiodarone. 68.7% were treated with amiodarone and 31.3% were treated with lidocaine. In each of the four primary outcomes following extensive risk adjustment for potential confounders, lidocaine showed a significant benefit over amiodarone. The primary outcomes, with associated adjusted odds ratio (aOR) and confidence interval (CI), were: return of spontaneous circulation (aOR, 1.15; CI, .5-4.2), 24-hour survival (aOR, 1.16; CI, 0 .9-5.1), survival to discharge (aOR, 1.19; CI, 1.5-5.2), and favorable neurologic outcome at hospital discharge (aOR, 1.18; CI, 1.3-4.9). Limitations of the study include it being an observational study as well as including a small selection of hospitals that may not be generalizable.
Bottom line: Patients who experience in-hospital cardiac arrest due to VT/VF that is refractory to defibrillation and CPR may benefit from the use of lidocaine versus amiodarone.
Citation: Wagner D, et al. Comparative effectiveness of amiodarone and lidocaine for the treatment of: in-hospital cardiac arrest. CHEST. 2022;S0012-3692(22)-4-39-9. doi:10.1016/j.chest.2022.10.024
Dr. Achilli is an academic hospitalist at Richmond Veterans Affairs Medical Center and an assistant professor of medicine at Virginia Commonwealth University in Richmond, Va.