Lidocaine outperforms amiodarone for in-hospital cardiac arrest

In the treatment of adult patients with in-hospital cardiac arrest, lidocaine appears to result in more favourable survival and neurological outcomes as compared with amiodarone, a study has shown.

The retrospective study involved 14,630 adult patients with in-hospital cardiac arrest due to ventricular tachycardia or ventricular fibrillation (VT/VF) who had inadequate response to cardiopulmonary resuscitation (CPR) and defibrillation.

Of the patients, 10,058 (68.7 percent) were treated with amiodarone and 4,572 (31.2 percent), with lidocaine. Multivariable logistic regression analyses showed that lidocaine-treated patients were more likely to achieve the primary outcome of return of spontaneous circulation (ROSC) than those treated with amiodarone (adjusted odds ratio [aOR], 1.15; p=0.01; average marginal effect [AME], 2.3, 95 percent confidence interval [CI], 0.5–4.2).

Additionally, lidocaine showed superiority over amiodarone in terms of 24-hour survival (aOR, 1.16; p=0.004; AME, 3.0, 95 percent CI, 0.9–5.1), survival to discharge (aOR, 1.19; p<0.001; AME, 3.3, 95 percent CI, 1.5–5.2), and favourable neurologic outcome at hospital discharge (aOR, 1.18; p<0.001; AME, 3.1, 95 percent CI, 1.3–4.9).

Similar results were obtained in an analysis that used propensity score methods.

The American Heart Association Advanced Cardiac Life Support guidelines recommend the use of either amiodarone or lidocaine for cardiac arrest due to VT/VF based on evidence gathered from studies of out-of-hospital cardiac arrest. The findings provide evidence on the efficacy of lidocaine vs amiodarone in the treatment of adult populations with in-hospital VT/VF.