Key result
Lidocaine achieved a 63.2% rate of return of spontaneous circulation compared to 55.3% with amiodarone in shock-refractory in-hospital cardiac arrest, a non-significant 7.9% difference.
Why the study?
Amiodarone and lidocaine are recommended for shock-refractory VF/pVT, but most comparative evidence comes from out-of-hospital cardiac arrest studies and their relative effectiveness in in-hospital cardiac arrest remained uncertain.
Does lidocaine improve return of spontaneous circulation (ROSC) and 24-hour survival compared to amiodarone in adult patients with shock-refractory in-hospital cardiac arrest (VF/pVT)?
RCT (n=76)
Random allocation (1:1)
No
Does lidocaine improve return of spontaneous circulation (ROSC) and 24-hour survival compared to amiodarone in adult patients with shock-refractory in-hospital cardiac arrest (VF/pVT)?
In adult patients with shock-refractory in-hospital cardiac arrest, lidocaine and amiodarone demonstrated comparable efficacy in achieving return of spontaneous circulation and 24-hour survival, with overall resuscitation duration being the primary predictor of survival.
Answers are grounded in this paper and cite their sources.
Lidocaine and amiodarone yield comparable ROSC rates in shock-refractory in-hospital arrest; extends prior out-of-hospital comparisons to this setting.
Background: In-hospital cardiac arrest (IHCA) is a critical medical emergency with high mortality despite advances in monitoring systems and resuscitation protocols. Shockable rhythms, particularly ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT), require rapid cardiopulmonary resuscitation (CPR), early defibrillation, and pharmacologic therapy when rhythms remain refractory. Antiarrhythmic agents such as amiodarone and lidocaine are recommended within Advanced Cardiac Life Support (ACLS) algorithms for shock-refractory VF/pVT. Although both drugs are widely used, most comparative evidence arises from out-of-hospital cardiac arrest studies, and their relative effectiveness in IHCA remains uncertain. Objective: To compare the effectiveness of amiodarone and lidocaine in restoring stable cardiac rhythm and improving early survival outcomes in patients experiencing in-hospital cardiac arrest with shockable rhythms. Methods: A randomized controlled trial was conducted among patients with IHCA presenting with ventricular fibrillation or pulseless ventricular tachycardia that persisted despite defibrillation. Participants were randomly assigned to receive either amiodarone or lidocaine according to standard ACLS protocols during resuscitation. The primary outcome was restoration of a stable cardiac rhythm with return of spontaneous circulation (ROSC). Secondary outcomes included survival at 24 hours following resuscitation. Data regarding timing of drug administration, rhythm conversion, and early survival outcomes were collected and analyzed to determine comparative effectiveness between the two antiarrhythmic agents. Results: Both amiodarone and lidocaine were effective in managing shock -refractory ventricular arrhythmias during IHCA. However, lidocaine demonstrated a slightly higher proportion of successful rhythm conversion and ROSC compared with amiodarone. Patients receiving lidocaine also showed marginally improved 24-hour survival rates. These findings suggest that while both agents function effectively as pharmacologic adjuncts during resuscitation, lidocaine’s rapid sodium-channel blockade and faster onset of action may contribute to a modest advantage in early rhythm stabilization and short-term outcomes. Conclusion: Both amiodarone and lidocaine remain clinically valuable antiarrhythmic options for the management of shockrefractory VF/pVT during IHCA. In this study, lidocaine showed a small but consistent advantage in achieving ROSC and early survival, indicating that it may be slightly more effective than amiodarone in the acute resuscitation phase. Further large -scale randomized trials are recommended to confirm these findings and refine antiarrhythmic protocols in IHCA management.
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P et al. (2026) conducted an RCT in In-hospital cardiac arrest with shock-refractory ventricular fibrillation or pulseless ventricular tachycardia (n=76). Lidocaine vs. Amiodarone was evaluated on Return of spontaneous circulation (ROSC) with stable cardiac rhythm (ARR 7.9%). Lidocaine achieved a 63.2% rate of return of spontaneous circulation compared to 55.3% with amiodarone in shock-refractory in-hospital cardiac arrest, a non-significant 7.9% difference.
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