Amiodarone or Lidocaine for In-Hospital Cardiac Arrest?

Should we be using amiodarone or lidocaine for patients who go into cardiac arrest due to ventricular tachycardia or ventricular fibrillation while in the hospital? The ACLS guidelines support the use of either. I have personally noted far more use of amiodarone over lidocaine for this issue. These data published in the May 2023 issue of Chest suggests otherwise. Hat tip to the authors. Read these data for yourself as there are limitations.

Since there isn’t much, if any data comparing the two, these authors performed a retrospective cohort study of patients with in-hospital cardiac arrest who either received lidocaine or amiodarone in addition to CPR and defibrillation to treat their vtach or vfib. They found that using lidocaine instead of amiodarone in cardiac arrest led to higher odds of ROSC, 24 h survival, survival to hospital discharge, and favorable neurologic outcome. The main limitation is that this is a retrospective study. Are these data enough to make you change your practice? Another new strategy is using glucocorticoids during cardiac arrest as well.

Citations for Amiodarone or Lidocaine in Cardiac Arrest

Wagner D, Kronick SL, Nawer H, Cranford JA, Bradley SM, Neumar RW. Comparative Effectiveness of Amiodarone and Lidocaine for the Treatment of In-Hospital Cardiac Arrest. Chest. 2023 May;163(5):1109-1119. doi: 10.1016/j.chest.2022.10.024. Epub 2022 Nov 2. PMID: 36332663.
Link to Article (NOT FREE)

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