Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation.
BACKGROUND
Lidocaine has been the initial antiarrhythmic drug treatment recommended for patients with ventricular fibrillation that is resistant to conversion by defibrillator shocks. We performed a randomized trial comparing intravenous lidocaine with intravenous amiodarone as an adjunct to defibrillation in victims of out-of-hospital cardiac arrest.


METHODS
Patients were enrolled if they had out-of-hospital ventricular fibrillation resistant to three shocks, intravenous epinephrine, and a further shock; or if they had recurrent ventricular fibrillation after initially successful defibrillation. They were randomly assigned in a double-blind manner to receive intravenous amiodarone plus lidocaine placebo or intravenous lidocaine plus amiodarone placebo. The primary end point was the proportion of patients who survived to be admitted to the hospital.


RESULTS
In total, 347 patients (mean [+/-SD] age, 67+/-14 years) were enrolled. The mean interval between the time at which paramedics were dispatched to the scene of the cardiac arrest and the time of their arrival was 7+/-3 minutes, and the mean interval from dispatch to drug administration was 25+/-8 minutes. After treatment with amiodarone, 22.8 percent of 180 patients survived to hospital admission, as compared with 12.0 percent of 167 patients treated with lidocaine (P=0.009; odds ratio, 2.17; 95 percent confidence interval, 1.21 to 3.83). Among patients for whom the time from dispatch to the administration of the drug was equal to or less than the median time (24 minutes), 27.7 percent of those given amiodarone and 15.3 percent of those given lidocaine survived to hospital admission (P=0.05).


CONCLUSIONS
As compared with lidocaine, amiodarone leads to substantially higher rates of survival to hospital admission in patients with shock-resistant out-of-hospital ventricular fibrillation.
Dorian
Paul
P
Departments of Medicine and Emergency Medicine, St. Michael's Hospital, Toronto. dorianp@smh.toronto.on.ca
Cass
Dan
D
Schwartz
Brian
B
Cooper
Richard
R
Gelaznikas
Robert
R
Barr
Aiala
A
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004554:Electric Countershock; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D008012:Lidocaine / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy
D000889:Anti-Arrhythmia Agents; D008012:Lidocaine; D000638:Amiodarone