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Sinha T, Reyaz I, Ibrahim RA, Guntha M, Zin AK, Chapala G, Ravuri MK, Palleti SK. Comparison of the Effects of Lidocaine and Amiodarone on Patients With Cardiac Arrest: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e56037. [PMID: 38623114 PMCID: PMC11017951 DOI: 10.7759/cureus.56037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/17/2024] Open
Abstract
The objective of this study was to compare the impact of amiodarone and lidocaine on survival and neurological outcomes following cardiac arrest. A systematic review of randomized controlled trials (RCTs) as well as cohort and cross-sectional trials was undertaken, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Potential relevant studies were searched in databases, including PubMed, Embase, Cochrane Library, and Web of Science, from the beginning of databases to February 15, 2024. Outcomes assessed in this study were survival to hospital discharge, survival to hospital admission or 24 hours, favorable neurological outcomes, and return of spontaneous circulation (ROSC). A total of seven studies (five observational and two RCTs) were included in this meta-analysis encompassing 19,081 patients with cardiac arrest. Pooled analysis showed no difference between amiodarone and lidocaine in terms of survival to hospital discharge (odds ratio (OR): 0.88, 95% confidence interval (CI): 0.75 to 1.04), ROSC (OR: 0.94, 95% CI: 0.84 to 1.05, p-value: 0.25), favorable neurological outcomes (OR: 0.88, 95% CI: 0.66 to 1.17, p-value: 0.38), and survival to 24 hours (OR: 0.82, 95% CI: 0.55 to 1.21, p-value: 0.31). While lidocaine demonstrated a slight survival advantage, the differences were statistically insignificant. Similarly, no significant variations were observed in ROSC incidence, neurological outcomes, or survival at 24 hours. These findings align with current guidelines but underscore the necessity for further rigorous RCTs to provide conclusive recommendations.
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Affiliation(s)
- Tanya Sinha
- Medical Education, Tribhuvan University, Kirtipur, NPL
| | - Ibrahim Reyaz
- Internal Medicine, Christian Medical College and Hospital, Ludhiana, IND
| | | | | | - Aung K Zin
- Internal Medicine, University of Medicine, Mandalay, Mandalay, MMR
| | - Grahitha Chapala
- Medicine and Surgery, Mkhitar Gosh Armenian Russian International University, Yerevan, ARM
| | - Mohan K Ravuri
- Medicine and Surgery, Mkhitar Gosh Armenian Russian International University, Yerevan, ARM
| | - Sujith K Palleti
- Nephrology, Louisiana State University Health Sciences Center, Shreveport, USA
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Güler S, Könemann H, Wolfes J, Güner F, Ellermann C, Rath B, Frommeyer G, Lange PS, Köbe J, Reinke F, Eckardt L. Lidocaine as an anti-arrhythmic drug: Are there any indications left? Clin Transl Sci 2023; 16:2429-2437. [PMID: 37781966 PMCID: PMC10719458 DOI: 10.1111/cts.13650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
Lidocaine is classified as a class Ib anti-arrhythmic that blocks voltage- and pH-dependent sodium channels. It exhibits well investigated anti-arrhythmic effects and has been the anti-arrhythmic of choice for the treatment of ventricular arrhythmias for several decades. Lidocaine binds primarily to inactivated sodium channels, decreases the action potential duration, and increases the refractory period. It increases the ventricular fibrillatory threshold and can interrupt life-threatening tachycardias caused by re-entrant mechanisms, especially in ischemic tissue. Its use was pushed into the background in the era of amiodarone and modern electric device therapy. Recently, lidocaine has come back into focus for the treatment of acute sustained ventricular tachyarrhythmias. In this brief overview, we review the clinical pharmacology including possible side effects, the historical course, possible indications, and current Guideline recommendations for the use of lidocaine.
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Affiliation(s)
- Sati Güler
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Hilke Könemann
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Julian Wolfes
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Fatih Güner
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Christian Ellermann
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Benjamin Rath
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Gerrit Frommeyer
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | | | - Julia Köbe
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Florian Reinke
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
| | - Lars Eckardt
- Department of Cardiology II: ElectrophysiologyUniversity Hospital MünsterMünsterGermany
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Huang CH, Yu PH, Tsai MS, Chuang PY, Wang TD, Chiang CY, Chang WT, Ma MHM, Tang CH, Chen WJ. Acute hospital administration of amiodarone and/or lidocaine in shockable patients presenting with out-of-hospital cardiac arrest: A nationwide cohort study. Int J Cardiol 2016; 227:292-298. [PMID: 27843049 DOI: 10.1016/j.ijcard.2016.11.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/10/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Terminating ventricular fibrillation (VF) or pulseless ventricular tachyarrhythmia (VT) is critical for successful resuscitation of patients with shockable cardiac arrest. In the event of shock-refractory VF, applicable guidelines suggest use of anti-arrhythmic agents. However, subsequent long-term outcomes remain unclear. A nationwide cohort study was therefore launched, examining 1-year survival rates in patients given amiodarone and/or lidocaine for cardiac arrest. METHODS Medical records accruing between years 2004 and 2011 were retrieved from the Taiwan National Health Insurance Research Database (NHIRD) for review. This repository houses all insurance claims data for nearly the entire populace (>99%). Candidates for study included all non-traumatized adults receiving DC shock and cardiopulmonary resuscitation immediately or within 6h of emergency room arrival. Analysis was based on data from emergency rooms and hospitalization. RESULTS One-year survival rates by treatment group were 8.27% (534/6459) for amiodarone, 7.15% (77/1077) for lidocaine, 11.10% (165/1487) for combined amiodarone/lidocaine use, and 3.26% (602/18,440) for use of neither amiodarone nor lidocaine (all, p<0.0001). Relative to those given neither medication, odds ratios for 1-year survival via multiple regression analysis were 1.84 (95% CI: 1.58-2.13; p<0.0001) for amiodarone, 1.88 (95% CI: 1.40-2.53; p<0.0001) for lidocaine, and 2.18 (95% CI: 1.71-2.77; p<0.0001) for dual agent use. CONCLUSIONS In patients with shockable cardiac arrest, 1-year survival rates were improved with association of using amiodarone and/or lidocaine, as opposed to non-treatment. However, outcomes of patients given one or both medications did not differ significantly in intergroup comparisons.
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Affiliation(s)
- Chien-Hua Huang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Hsun Yu
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Ya Chuang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Tzung-Dau Wang
- Department of Internal Medicine (Cardiology), College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Yen Chiang
- Division of Cardiology, Department of Internal Medicine, Cardinal Tien Hospital Yonghe Branch, New Taipei City, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan.
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Sanfilippo F, Corredor C, Santonocito C, Panarello G, Arcadipane A, Ristagno G, Pellis T. Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis. Resuscitation 2016; 107:31-7. [DOI: 10.1016/j.resuscitation.2016.07.235] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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MESH Headings
- Adolescent
- Advanced Cardiac Life Support/instrumentation
- Advanced Cardiac Life Support/methods
- Advanced Cardiac Life Support/standards
- Airway Obstruction/complications
- Airway Obstruction/diagnosis
- Airway Obstruction/therapy
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Australia
- Cardiovascular Agents/therapeutic use
- Catheterization/methods
- Catheterization/standards
- Child
- Child, Preschool
- Clinical Protocols
- Electric Countershock/instrumentation
- Electric Countershock/methods
- Electric Countershock/standards
- Electrocardiography/instrumentation
- Electrocardiography/standards
- Heart Arrest/complications
- Heart Arrest/diagnosis
- Heart Arrest/therapy
- Heart Massage/methods
- Heart Massage/standards
- Humans
- Infant
- Infant, Newborn
- Intubation, Intratracheal/methods
- Intubation, Intratracheal/standards
- Monitoring, Physiologic/methods
- Monitoring, Physiologic/standards
- Oxygen Inhalation Therapy/instrumentation
- Oxygen Inhalation Therapy/methods
- Oxygen Inhalation Therapy/standards
- Pediatrics/methods
- Pediatrics/standards
- Respiration, Artificial/instrumentation
- Respiration, Artificial/methods
- Respiration, Artificial/standards
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Rea RS, Kane-Gill SL, Rudis MI, Seybert AL, Oyen LJ, Ou NN, Stauss JL, Kirisci L, Idrees U, Henderson SO. Comparing intravenous amiodarone or lidocaine, or both, outcomes for inpatients with pulseless ventricular arrhythmias*. Crit Care Med 2006; 34:1617-23. [PMID: 16614583 DOI: 10.1097/01.ccm.0000217965.30554.d8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare survival rates of patients with in-hospital cardiac arrest due to pulseless ventricular tachycardia/ventricular fibrillation treated with lidocaine, amiodarone, or amiodarone plus lidocaine. DESIGN Multicenter retrospective medical record review. SETTING Three academic medical centers in the United States. PATIENTS Hospitalized adult patients who received amiodarone, lidocaine, or a combination for pulseless ventricular tachycardia/ventricular fibrillation between August 1, 2000, and July 31, 2002. MEASUREMENTS AND MAIN RESULTS Data were collected according to the Utstein style. In-hospital proportion of patients living at 24 hrs and discharge were analyzed using chi-square analysis. Of the 605 patient medical records reviewed, 194 met criteria for inclusion (n=79 for lidocaine, n=74 for amiodarone, n=41 for combination). Available data showed no difference in proportion of patients alive 24 hrs post-cardiac arrest (p=.39). Cox regression analysis indicated a decreased likelihood of survival in patients with pulseless ventricular tachycardia/ventricular fibrillation as an initial rhythm as compared with those who presented with bradycardia followed by pulseless ventricular tachycardia/ventricular fibrillation and in those patients who received amiodarone as compared with lidocaine. However, only 14 patients (25%) in the amiodarone group received the recommended initial 300-mg intravenous bolus, and amiodarone was administered an average of 8 mins later in the code compared with lidocaine (p<.001). CONCLUSIONS These results generate the hypothesis that inpatients with cardiac arrest may have different benefits from lidocaine and amiodarone than previously demonstrated. Inadequate dosing and later administration of amiodarone in the code were two confounding factors in this study. Prospective studies evaluating these agents are warranted.
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Affiliation(s)
- Rhonda S Rea
- University of Pittsburgh School of Pharmacy, Center for Pharmacoinformatics and Outcomes Research, Department of Pharmaceutical Sciences, PA, and Saint Mary's Hospital-Mayo Foundation, Rochester, MN, USA
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Abstract
Cardiac disease is the most common cause of death in the United States, and sudden cardiac arrest frequently claims the lives of men and women during their most productive years. It is believed that much better survival rates can be achieved for victims of cardiac arrest through optimizing the "chain of survival" as described by the American Heart Association. The relative and incremental benefit of full prehospital ACLS over basic life support and defibrillation is unproven, however. This is an important issue in this era of cost containment. Some of the ongoing studies including the OPALS study may clarify the cost effectiveness and relative efficacy of rapid defibrillation and full ACLS programs for victims of prehospital cardiac arrest [6].
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Affiliation(s)
- Alok Maheshwari
- Thoracic and Cardiovascular Institute, Sparrow Health System, Michigan State University, 1200 E, Michigan Avenue, Suite 525, East Lansing, MI 48912, USA
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Abstract
As exemplified in this discussion of ACLS antiarrhythmic drugs, the evidence-based evaluation process has created a high standard for the acceptance and ranking of therapies for cardiac arrest. This process also has identified critical areas needing further investigation, fostered a healthy sense of discomfort with the adequacy of our present interventions for cardiac arrest, and hopefully will continue to spur the science while sifting the dogma out of CPR.
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Affiliation(s)
- Peter J Kudenchuk
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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9
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Robertson C, Summers IR. The use of anti-arrhythmic agents in cardiopulmonary resuscitation. Best Pract Res Clin Anaesthesiol 2000. [DOI: 10.1053/bean.2000.0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Lidocaine has been used as the primary antiarrhythmic agent for ventricular arrhythmias during acute myocardial infarction (MI) and open heart surgery. Its cardioprotective effects have been studied in experimental settings and also during angioplastic reperfusion and coronary revascularisation. The basic mechanism of action, probably also involved with cardioprotection, has been demonstrated to be blockade of cardiac sodium channels. In this open study we investigated the contribution of continuous lidocaine infusion to cardioprotection during coronary revascularisation with blood cardioplegia. METHODS During coronary revascularisation with cold blood cardioplegia, a study group of 50 patients received a prophylactic lidocaine infusion for 20 h started with a bolus dose before aortic clamping; another group of 50 patients without the infusion served as a control group. Serum troponin T concentration, serum creatine kinase MB activity and electrocardiography were the main parameters recorded. RESULTS Serial measurement of Troponin T (P = 0.06) and CK-MB values: (P = 0.09) were slightly lower in the lidocaine group, but the differences were not statistically significant. CONCLUSION Lacking statistically significant evidence of improved cardioprotection, lidocaine infusion cannot be recommended as a routine treatment during coronary revascularisation.
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Affiliation(s)
- T Rinne
- Department of Anaesthesia and Intensive Care, Tampere University Hospital, Finland
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Ornato JP, Paradis N, Bircher N, Brown C, DeLooz H, Dick W, Kaye W, Levine R, Martens P, Neumar R, Patel R, Pepe P, Ramanathan S, Rubertsson S, Traystman R, von Planta M, Vostrikov V, Weil MH. Future directions for resuscitation research. III. External cardiopulmonary resuscitation advanced life support. Resuscitation 1996; 32:139-58. [PMID: 8896054 DOI: 10.1016/0300-9572(96)00979-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This discussion about advanced cardiac life support (ACLS) reflects disappointment with the over 50% of out-of-hospital cardiopulmonary resuscitation (CPR) attempts that fail to achieve restoration of spontaneous circulation (ROSC). Hospital discharge rates are equally poor for in-hospital CPR attempts outside special care units. Early bystander CPR and early defibrillation (manual, semi-automatic or automatic) are the most effective methods for achieving ROSC from ventricular fibrillation (VF). Automated external defibrillation (AED), which is effective in the hands of first responders in the out-of-hospital setting, should also be used and evaluated in hospitals, inside and outside of special care units. The first countershock is most important. Biphasic waveforms seem to have advantages over monophasic ones. Tracheal intubation has obvious efficacy when the airway is threatened. Scientific documentation of specific types, doses, and timing of drug treatments (epinephrine, bicarbonate, lidocaine, bretylium) are weak. Clinical trials have failed so far to document anything statistically but a breakthrough effect. Interactions between catecholamines and buffers need further exploration. A major cause of unsuccessful attempts at ROSC is the underlying disease, which present ACLS guidelines do not consider adequately. Early thrombolysis and early coronary revascularization procedures should also be considered for selected victims of sudden cardiac death. Emergency cardiopulmonary bypass (CPB) could be a breakthrough measure, but cannot be initiated rapidly enough in the field due to technical limitations. Open-chest CPR by ambulance physicians deserves further trials. In searches for causes of VF, neurocardiology gives clues for new directions. Fibrillation and defibrillation thresholds are influenced by the peripheral sympathetic and parasympathetic nervous systems and impulses from the frontal cerebral cortex. CPR for cardiac arrest of the mother in advanced pregnancy requires modifications and outcome data. Until more recognizable critical factors for ROSC are identified, titrated sequencing of ACLS measures, based on physiologic rationale and sound judgement, rather than rigid standards, gives the best chance for achieving survival with good cerebral function.
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Affiliation(s)
- P E Pepe
- Department of Medicine, Baylor College of Medicine, Houston, Texas
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