JOURNAL ARTICLE

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
36332663

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.

Full Text Links

We have located links that may give you full text access.

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read
36332663
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.