Lidocaine and amiodarone are both included in the pediatric cardiac arrest guidelines as treatments of shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, although there is limited evidence to support this recommendation.
A study was conducted to find out which of lidocaine or amiodarone is acceptable and preferred over another in PALS for shock-refractory ventricular fibrillation. This was a propensity matching study based on a pediatric in-hospital arrest registry over an 18 year period with shock-refractory v-fib or pulseless v-tach.
The researchers included pediatric patients (≤18 years) with an in-hospital cardiac arrest between 2000 and 2018, who presented with an initial or subsequent shockable rhythm (ventricular fibrillation and pulseless ventricular tachycardia) in this cohort study. A total of 365 patients were available for the analysis, of which 180 (49%) patients were matched on the propensity score. The median age in the raw cohort was 6 (quartiles, 0.5-14) years, 164 (45%) patients were female, and 238 (65%) patients received an antiarrhythmic for an initial shockable rhythm.
They matched 90 patients in each group, with the only difference being the administration of lidocaine or amiodarone. I won't put all the risk ratios or 95%CI, as they were almost all near 1.
There was no difference in return of spontaneous circulation, 24-hour survival, survival to discharge, or survival with favourable neurological outcome comparing lidocaine to amiodarone. The results remained consistent in multiple sensitivity analyses.
Again, despite this being a large registry with 18 years of data, the total number of patients they were able to include was small. Although propensity matching helps, there is always a danger of confounding. However, in this study, it looks like it really doesn't matter which agent you choose for the next round of PALS if defibrillation fails.
The researchers concluded that there was no significant difference in clinical outcomes between those receiving lidocaine compared to amiodarone In children with cardiac arrest receiving antiarrhythmics for a shockable rhythm.
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DOI: 10.1016/j.resuscitation.2019.12.033.