Comparative Effectiveness of Amiodarone Versus Lidocaine as Antiarrhythmic Therapy for Cardiac Arrest with Shockable Rhythms: A Systematic Review and Meta-Analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cardiac arrest with shockable rhythms (ventricular fibrillation or pulseless ventricular tachycardia) (n=50773). Intervention: Amiodarone vs. Lidocaine. Primary outcome: Return of spontaneous circulation (ROSC) (RR 0.96, 95% CI 0.87-1.06, p=0.40).

Q: What does this research mean for the field?

There is no significant difference in overall survival between amiodarone and lidocaine for cardiac arrest with shockable rhythms, though lidocaine is associated with more favorable short-term in-hospital outcomes. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Faizan Ahmed; Ayesha Zulfiqar; Tooba Nihal; Maliha Khalid; M. Rafiqul Islam; Fnu Abubakar; Noor ul Ain Saleem; Haris Bin Tahir; Hafsa Arshad Azam Raja; A.Rashid Dar; Omar Kamel; Faseeh Haider; Saman Rauf; Wania Ayub; Khush Dadhania; Mobeen Zaka Haider; Yasar Sattar; Amro Taha

doi:10.3390/jcm15187274

Key result

Amiodarone shows no benefit over lidocaine for ROSC in shockable cardiac arrest.

RR 0.96
95% CI 0.87-1.06
P=0.40
n=50,773

Figures

Why the study?

Does amiodarone improve resuscitation outcomes and survival compared to lidocaine in patients with cardiac arrest due to shockable rhythms?

Key Points

To evaluate the comparative effectiveness of amiodarone versus lidocaine on resuscitation and survival outcomes in patients with shockable cardiac arrest across in-hospital and out-of-hospital settings.
Systematic review and meta-analysis of 14 studies (2 randomized controlled trials, 2 prospective cohorts, and 10 retrospective observational cohorts) comprising 50,773 patients (39,506 received amiodarone and 11,267 received lidocaine).
Queried PubMed, ScienceDirect, Embase, and Cochrane Library for studies examining in-hospital cardiac arrest (IHCA; n = 15,806) and out-of-hospital cardiac arrest (OHCA; n = 34,967).
Conducted random-effects meta-analyses and Bayesian meta-analyses in R to evaluate return of spontaneous circulation, survival milestones, and neurological recovery.
Return of spontaneous circulation did not differ between amiodarone and lidocaine overall (RR = 0.96, 95% CI = 0.87–1.06, p = 0.40), and overall survival to discharge was also similar (RR = 0.91, 95% CI = 0.82–1.02, p = 0.11).
For out-of-hospital cardiac arrest, survival to discharge did not differ between agents (RR = 0.93, 95% CI = 0.76–1.13, p = 0.44), with Bayesian analyses confirming overlapping credible intervals and no distinct superiority for either antiarrhythmic.

Study Design

Type

Meta-Analysis (n=50,773)

Multicenter

Yes

Structured PICO

Does amiodarone improve resuscitation outcomes and survival compared to lidocaine in patients with cardiac arrest due to shockable rhythms?

P

Population

50,773 patients with in-hospital or out-of-hospital cardiac arrest due to shockable rhythms (mean age 64.8 years) included across 14 studies.

I

Intervention

Amiodarone administered via intravenous (IV) or intraosseous (IO) route

C

Comparator

Lidocaine administered via intravenous (IV) or intraosseous (IO) route

O

Outcome

Return of Spontaneous Circulation (ROSC), Survival to Hospital Discharge, 24 h Survival, and Favourable Neurological Outcomehard clinical

Main Result

Relative Risk: 0.96 (95% CI 0.87–1.06)

p-value: p=0.40

Amiodarone does not provide a survival benefit over lidocaine for shockable cardiac arrest and may be associated with worse in-hospital outcomes, suggesting either agent can be used based on availability.

Limitations

Majority of included studies were observational and susceptible to confounding by indication
Variations in the timing of drug administration relative to defibrillation attempts
Differences in comorbidity prevalence not controlled uniformly
Substantial heterogeneity in out-of-hospital cardiac arrest studies
Exclusion of non-English-language publications (language bias)
Substantial clinical and methodological heterogeneity among included studies
Potential publication bias or small-study effects indicated by funnel-plot asymmetry
Predominantly based on observational cohorts with inherent confounding risks

Implication

Amiodarone and lidocaine yield similar ROSC rates in shockable arrest; confirms equivalence overall while leaving IHCA survival differences open for further RCTs.

Abstract

Background: Amiodarone and lidocaine are antiarrhythmic agents recommended for advanced cardiac life support in shockable ventricular arrhythmias during cardiac arrest, yet their comparative effectiveness in in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) remains uncertain. Methods: From 930 records identified in PubMed, ScienceDirect, Embase, and Cochrane Library, 14 studies were included. Outcomes were analyzed using random-effects meta-analysis in R with IHCA and OHCA subgroup analyses. Bayesian meta-analysis using the bayesmeta package assessed result credibility. Results: Amiodarone did not improve return of spontaneous circulation (R0SC) compared with lidocaine (Risk ratio (RR) 0.96, p = 0.40). In IHCA, amiodarone was associated with lower survival to hospital discharge (RR 0.88, p < 0.0001), lower 24 h survival (RR 0.93, p < 0.0001), worse neurological recovery (RR 0.83, p < 0.0001), and longer arrest duration (Mean difference (MD) 7.46 min, p = 0.002). Termination of shockable rhythms favored lidocaine only after sensitivity analysis (RR 0.51, p = 0.02). In OHCA, amiodarone did not improve survival to discharge (RR 0.93, p = 0.44), while return of spontaneous circulation favored lidocaine after sensitivity analysis (RR 0.88, p = 0.002). No consistent benefit was observed across outcomes. Bayesian analysis showed overlapping credible intervals and low probabilities of benefit, indicating no clear superiority. Conclusions: No survival difference was observed between amiodarone and lidocaine arrest. Although lidocaine showed more favorable in-hospital outcomes, long-term survival was similar, suggesting agents may be selected based on availability and practice.

Discussion

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Cite This Study

Ahmed et al. (2026) conducted a meta-analysis in Cardiac arrest with shockable rhythms (ventricular fibrillation or pulseless ventricular tachycardia) (n=50,773). Amiodarone vs. Lidocaine was evaluated on Return of spontaneous circulation (ROSC) (RR 0.96, 95% CI 0.87-1.06, p=0.40). Amiodarone did not improve return of spontaneous circulation compared with lidocaine (RR 0.96) in patients with cardiac arrest and shockable rhythms.

synapsesocial.com/papers/6ab344a08f706e25623b174e https://doi.org/10.3390/jcm15187274

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Comparative Effectiveness of Amiodarone Versus Lidocaine as Antiarrhythmic Therapy for Cardiac Arrest with Shockable Rhythms: A Systematic Review and Meta-Analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Comparative Effectiveness of Amiodarone Versus Lidocaine as Antiarrhythmic Therapy for Cardiac Arrest with Shockable Rhythms: A Systematic Review and Meta-Analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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