Lidocaine better than amidorone in improving survival in patients of in-hospital cardiac arrest

A new study published in the Chest Journal shows that in patients undergoing in-hospital cardiac arrest (IHCA) brought on by ventricular fibrillation (VF) or ventricular tachycardia (VT), lidocaine may produce better results than amiodarone.

Based on studies of cardiac arrests that occurred outside of hospitals, the Advanced Cardiac Life Support (ACLS) guidelines of the American Heart Association (AHA) recommend the use of either amiodarone or lidocaine for cardiac arrest caused by VT/VF. There aren't many studies comparing amiodarone and lidocaine in adult populations experiencing VT/VF arrest in-hospital. In order to determine if treatment with amiodarone vs. lidocaine therapy had distinct relationships with outcomes among adult patients who experience in-hospital cardiac arrest from VT/VF, Deborah Wagner and colleagues undertook this study.

Adult patients who experienced VT/VF in-hospital cardiac arrest that was resistant to cardiopulmonary resuscitation (CPR) and defibrillation between January 1, 2000, and December 31, 2014, within the American Heart Association Get With the Guidelines-Resuscitation® (GWTG-R) participating hospitals, were the subject of a retrospective cohort study. The main result was the resumption of spontaneous circulation (ROSC). Positive neurological outcomes, 24-hour survival, and survival to hospital release were secondary outcomes.

The key findings of this study were:

1. 68.7% (n=10,058) of the 14,630 patients with in-hospital VT/VF arrest received amiodarone, whereas 31.2% (n=4,572) received lidocaine.

2. When all covariates were statistically controlled, lidocaine was associated with statistically significantly higher odds of:

    a) ROSC, adjusted odds ratio (AOR)=1.15, p=0.01, average marginal effect (AME)=2.3, 95% confidence interval (CI)=.5, 4.2);

    b) 24-hour survival, AOR=1.16, p=.004, AME=3.0, 95% CI=0.9, 5.1;

    c) survival to discharge, AOR=1.19, Results from multivariable logistic regression analysis and propensity score techniques were comparable.

In conclusion, adult patients with IHCA from VT/VF who received lidocaine treatment had statistically substantially higher rates of ROSC, 24-hour surviving, survival to hospital discharge, and good neurological outcomes compared to those who received amiodarone.

Reference:

Wagner, D., Kronick, S. L., Nawer, H., Cranford, J. A., Bradley, S. M., & Neumar, R. W. (2022). Comparative Effectiveness of Amiodarone and Lidocaine for Treatment of In-Hospital Cardiac Arrest (IHCA). In Chest. Elsevier BV. https://doi.org/10.1016/j.chest.2022.10.024