title: Amiodarone Versus Lidocaine for Pediatric Cardiac Arrest Due to Ventricular Arrhythmias: A Systematic Review.
abstract: We performed a systematic review as part of the International Liaison Committee on Resuscitation process to create a consensus on science statement regarding amiodarone or lidocaine during pediatric cardiac arrest for the 2015 International Liaison Committee on Resuscitation's Consensus on Science and Treatment Recommendations.
  
  
  
  Studies were identified from comprehensive searches in PubMed, Embase, and the Cochrane Library.
  
  
  
  Studies eligible for inclusion were randomized controlled and observational studies on the relative clinical effect of amiodarone or lidocaine in cardiac arrest.
  
  
  
  Studies addressing the clinical effect of amiodarone versus lidocaine were extracted and reviewed for inclusion and exclusion criteria by the reviewers. Studies were rigorously analyzed thereafter.
  
  
  
  We identified three articles addressing lidocaine versus amiodarone in cardiac arrest: 1) a prospective study assessing lidocaine versus amiodarone for refractory ventricular fibrillation in out-of-hospital adults; 2) an observational retrospective cohort study of inpatient pediatric patients with ventricular fibrillation or pulseless ventricular tachycardia who received lidocaine, amiodarone, neither or both; and 3) a prospective study of ventricular tachycardia with a pulse in adults. The first study showed a statistically significant improvement in survival to hospital admission with amiodarone (22.8% vs 12.0%; p = 0.009) and a lack of statistical difference for survival at discharge (p = 0.34). The second article demonstrated 44% return of spontaneous circulation for amiodarone and 64% for lidocaine (odds ratio, 2.02; 1.36-3.03) with no statistical difference for survival at hospital discharge. The third article demonstrated 48.3% arrhythmia termination for amiodarone versus 10.3% for lidocaine (p < 0.05). All were classified as lower quality studies without preference for one agent.
  
  
  
  The confidence in effect estimates is so low that International Liaison Committee on Resuscitation felt that a recommendation to use of amiodarone over lidocaine is too speculative; we suggest that amiodarone or lidocaine can be used in the setting of pulseless ventricular tachycardia/ventricular fibrillation in infants and children.
authors.affiliation: 1Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. 2Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. 3Health Sciences Library, St. Michael's Hospital, Toronto, ON, Canada. 4Department of Pediatrics, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada. 5Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: McBride
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Marino
authors.forename: Gregory
authors.initials: G
authors.lastname: Webster
authors.forename: Jesús
authors.initials: J
authors.lastname: Lopez-Herce
authors.forename: Carolyn P
authors.initials: CP
authors.lastname: Ziegler
authors.forename: Allan R
authors.initials: AR
authors.lastname: De Caen
authors.forename: Dianne L
authors.initials: DL
authors.lastname: Atkins
mesh_terms: D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D004554:Electric Countershock; D006323:Heart Arrest / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D010372:Pediatrics; D012151:Resuscitation / Q000379:methods*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications* / Q000188:drug therapy
chemical_list: D000889:Anti-Arrhythmia Agents; D008012:Lidocaine; D000638:Amiodarone