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Effectiveness of antiarrhythmic drugs for shockable cardiac arrest: A systematic review

Muhammad Usman Ali1, Donna Fitzpatrick-Lewis2, Meghan Kenny1

  • 1McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario, L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada.

Resuscitation
|September 5, 2018
PubMed

Insights

Antiarrhythmic drugs show no benefit for survival in shockable cardiac arrest. Lidocaine may improve return of spontaneous circulation, but more research is needed for critical outcomes.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Pharmacology

Background:

  • Cardiac arrest management guidelines emphasize timely interventions.
  • Antiarrhythmic drugs are frequently used in advanced cardiac life support protocols.
  • Evidence on their effectiveness in shockable cardiac arrest requires regular updates.

Purpose of the Study:

  • To systematically review current evidence on antiarrhythmic drug efficacy in shockable cardiac arrest.
  • To inform the 2018 International Liaison Committee on Resuscitation Consensus on Science with Treatment Recommendations.
  • To evaluate outcomes such as survival and neurological function.

Main Methods:

  • Comprehensive search of Medline, Embase, and Cochrane Library databases.
  • Inclusion of randomized controlled trials (RCTs) and observational studies up to August 2017.
  • Analysis of adult and pediatric populations separately.

Main Results:

  • RCTs in adults found no significant difference for antiarrhythmic drugs versus placebo for survival to discharge or good neurological function.
  • Lidocaine showed a statistically significant increase in return of spontaneous circulation compared to placebo (RR=1.16; 95% CI, 1.03-1.29).
  • Limited evidence exists for pediatric populations and specific post-resuscitation scenarios.

Conclusions:

  • High-level evidence for antiarrhythmic drug benefit in shockable cardiac arrest is limited.
  • No demonstrated benefit for critical outcomes like survival or neurological function.
  • Further research is essential to clarify the role of these drugs, especially in pediatric cases and post-ROSC adults.
Abstract

Keywords:
Antiarrhythmic drugsCardiac arrestGood neurological functionPulseless ventricular tachycardia or ventricular fibrillationReturn of spontaneous circulation

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