Lidocaine in prehospital countershock refractory ventricular fibrillation

Drug management of out-of-hospital countershock refractory ventricular fibrillation was evaluated by including 100 mg lidocaine bolus intravenously as the only anti-arrhythmic option in a protocol for use by paramedics. One hundred sixteen patients entered the study by failing to convert from ventricular fibrillation after the sequence of countershock, sodium bicarbonate, and repeat countershock. Sixty-two patients (53%) received lidocaine during the course of attempted resuscitation (Group I); 54 patients (47%) did not receive lidocaine (Group II). The two groups did not have significant differences in response times, patient profiles, or the use of other drugs or procedures. In Group I, 28 patients (45%) remained in ventricular fibrillation on arrival at the hospital, 15 (24%) were admitted to the CCU, and seven (11%) were ultimately discharged. In Group II, 25 patients (46%) remained in ventricular fibrillation on arrival at the hospital, eight (17%) survived to be admitted to the hospital, and one (2%) was ultimately discharged. The ability to convert ventricular fibrillation and the number of short- and long-term survivors did not differ significantly between the two groups. We conclude that a well-documented, controlled study of prehospital drug management of ventricular fibrillation is possible, and that further clinical evaluation of drug use in countershock refractory ventricular fibrillation is needed.