Key result
Amiodarone and lidocaine fail to improve survival to discharge in nonshockable-turned-shockable OHCA.
Why the study?
It is unknown whether antiarrhythmic drugs are safe and effective when nonshockable rhythms evolve to shockable rhythms during resuscitation of OHCA.
Do amiodarone or lidocaine improve survival to hospital discharge in adults with nonshockable-turned-shockable out-of-hospital cardiac arrest compared to placebo?
Population
1063 adults with nontraumatic OHCA initially nonshockable then shock-refractory VF/VT
Comparison
Amiodarone or lidocaine vs placebo administered by paramedics
Design
Prospective randomized double-blind trial
Follow-up
Survival to hospital discharge
Authors
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Does not support amiodarone or lidocaine use; reinforces focus on CPR and defibrillation over antiarrhythmics in this population.
RCT (n=1,063)
Double-blind
randomized
Do amiodarone or lidocaine improve survival to hospital discharge in adults with nonshockable-turned-shockable out-of-hospital cardiac arrest compared to placebo?
Absolute Risk Reduction: 2.3 (95% CI -0.3–4.8)
Absolute Event Rate: 4.1% vs 1.9%
Absolute Risk Reduction: 2.3%
p-value: p=0.08
In patients with nonshockable-turned-shockable out-of-hospital cardiac arrest, amiodarone and lidocaine showed non-statistically significant trends toward improved survival to hospital discharge compared to placebo.
Kudenchuk et al. (2017) conducted an RCT in Out-of-hospital cardiac arrest (OHCA) (n=1,063). Amiodarone or lidocaine vs. Placebo was evaluated on survival to hospital discharge (Absolute difference 2.3%, 95% CI -0.3, 4.8, p=0.08). Amiodarone and lidocaine did not significantly improve survival to hospital discharge compared to placebo in nonshockable-turned-shockable out-of-hospital cardiac arrest (4.1%, 3.1%, and 1.9%; P=0.24).
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