Amiodarone versus lidocaine versus placebo for refractory out-of-hospital cardiac arrest

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Out-of-hospital cardiac arrest is one of the leading causes of death worldwide. Antiarrhythmic therapy with amiodarone and lidocaine has been shown to increase survival to hospital arrival, but their effects on survival to hospital discharge and discharge with good neurologic function is unknown. In a randomized trial comparing amiodarone, lidocaine, and placebo in patients with pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) refractory to defibrillation and initial vasopressor therapy, there was no difference in the primary outcome (survival to hospital discharge) between the three groups, although there was a suggestion of improved survival in both the amiodarone and lidocaine groups compared with placebo [2]. These data are consistent with the 2015 American Heart Association (AHA) guideline approach to therapy, in which amiodarone and lidocaine “may be considered” for patients with VF or pulseless VT that is refractory to initial treatments. Further studies are needed to identify patients who are more likely to benefit from antiarrhythmic drug therapy. (See “Supportive data for advanced cardiac life support in adults with sudden cardiac arrest”, section on ‘Comparison of amiodarone and lidocaine’.)

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