Comparative Effectiveness of Amiodarone and Lidocaine for Treatment of In-Hospital Cardiac Arrest (IHCA)

Deborah Wagner, S L Kronick, H Nawer, J A Cranford, S M Bradley, R W Neumar
Chest 2022 November 1

BACKGROUND: American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) guidelines support the use of either amiodarone or lidocaine for cardiac arrest due to ventricular tachycardia or ventricular fibrillation (VT/VF) based on studies of out of hospital cardiac arrest. Studies comparing amiodarone and lidocaine in adult populations with in-hospital VT/VF arrest are lacking.

RESEARCH QUESTION: Does treatment with amiodarone vs. lidocaine therapy have differential associations with outcomes among adult patients with in-hospital cardiac arrest (IHCA) from VT/VF?

STUDY DESIGN AND METHODS: Retrospective cohort study of adult patients receiving amiodarone or lidocaine for VT/VF in-hospital cardiac arrest refractory to cardiopulmonary resuscitation (CPR) and defibrillation between January 1, 2000, to December 31, 2014, within the American Heart Association Get With the Guidelines-Resuscitation® (GWTG-R) participating hospitals. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes were 24-hour survival, survival to hospital discharge, and favorable neurological outcome.

RESULTS: Among 14,630 patients with in-hospital VT/VF arrest, 68.7% (n=10,058) were treated with amiodarone and 31.2% (n=4,572) were treated with lidocaine. When all covariates were statistically controlled, compared with amiodarone, 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% 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, p < 0.001, AME=3.3, 95% CI=1.5, 5.2; and d) favorable neurologic outcome at hospital discharge, AOR=1.18, p < .001, AME=3.1, 95% CI = 1.3, 4.9. Results using propensity score methods were similar to those from multivariable logistic regression analyses.

INTERPRETATION: Compared with amiodarone, lidocaine therapy among adult patients with IHCA from VT/VF was associated with statistically significantly higher rates of ROSC, 24-hour survival, survival to hospital discharge, and favorable neurological outcome.

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