After three defibrillation attempts, recommendations state that amiodarone or lidocaine may be considered for patients with cardiac arrest and persistent shockable rhythm. A randomized, controlled trial was conducted and showed there was no significant difference between amiodarone and lidocaine and only minor benefits of either agent versus placebo.
Small but significant improvements in the odds of survival at hospital admission were observed in a systemic review of patients with cardiac arrest who received amiodarone, lidocaine, or placebo. The review indicated for amiodarone versus placebo, the odds ratio was 1.25, and for lidocaine versus placebo, the odds ratio was 1.34. Overall, neither agent significantly improved the odds of good neurological outcome nor the odds of survival at hospital discharge.
These results add mild support for current recommendations to consider amiodarone or lidocaine for grim cases in which three defibrillation attempts have failed.
- Sanfilippo F et al. Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis. Resuscitation 2016 Aug 2; [e-pub]. (http://dx.doi.org/10.1016/j.resuscitation.2016.07.235)