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Comparative Effectiveness of Lidocaine and Amiodarone for Refractory VF/pVT in Adult In-Hospital Cardiac Arrest:
Xu Niu1, Tangxing Jiang1, Wen Zheng1
1Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China; Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China; Medical and Pharmaceutical Basic Research Innovation Center of Emergency and Critical Care Medicine, China's Ministry of Education, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital of Shandong University, Jinan, China; State Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China.
Background:
Current resuscitation guidelines recommend either amiodarone or lidocaine for refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), primarily based on out-of-hospital cardiac arrest evidence. Whether the two agents differ in effectiveness for adult in-hospital cardiac arrest (IHCA) with refractory VF/pVT remains uncertain.
Research Question:
Among adult IHCA patients with refractory VF/pVT, does lidocaine differ from amiodarone in survival or neurological outcomes?
Study Design And Methods:
We conducted data analysis based on a nationwide, multicenter, prospective Baseline Investigation of In-Hospital Cardiac Arrest (BASIC-IHCA) registry, which collects Utstein-style IHCA data from 40 hospitals across China. We included adults with refractory VF/pVT who received lidocaine or amiodarone between July 2019 and December 2020. All eligible cases were carefully adjudicated by reviewing medical records to ensure strict adherence to the recommended indications for medication in the guidelines. The primary outcome was survival to hospital discharge or 30 days; secondary outcomes were sustained return of spontaneous circulation (ROSC) and favorable neurological outcome at discharge or 30 days (CPC 1/2). Associations were evaluated using multilevel mixed-effects logistic regression with prespecified subgroup analyses.
Results:
Of 32,545 adult IHCA cases, 612 met inclusion criteria (lidocaine: n=259; amiodarone: n=353). Unadjusted outcomes were similar between groups: survival (20.1% vs. 23.5%; P=0.31), sustained ROSC (47.9% vs. 51.6%; P=0.38), and favorable neurological status (17.0% vs. 21.0%; P=0.22). After multivariable adjustment, no significant differences were observed for survival (adjusted OR 1.22; 95% CI 0.63-2.37; P=0.55); sustained ROSC (adjusted OR 1.21; 95% CI 0.77-1.91; P=0.40); or neurological outcome (adjusted OR 1.44; 95% CI 0.70-2.99; P=0.32), with consistent exploratory subgroup findings.
Interpretation:
To our knowledge, this is the first study to compare lidocaine and amiodarone specifically in a rigorously adjudicated cohort of adult refractory VF/pVT IHCA patients from a national, multicenter prospective registry. We observed no significant differences in outcomes between the two agents, providing real-world evidence that supports guideline recommendations allowing either antiarrhythmic drug during resuscitation.
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