Antiarrhythmic drugs - no survival difference

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I've got rhythm...
An article in NEJM in April found that neither amiodarone nor lidocaine made an impact on survival or neurological outcome for out-of-hospital arrest due to v-fib or pulseless v-tach.  More survived to admission, just not to discharge.  This systematic review of seven studies mirrored those results.

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Amiodarone and lidocaine are associated with increased survival to admission but not survival to discharge.  As more evidence like this mounts, we may see resuscitation algorithms change.  LITFL covered this article and more.

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Resuscitation. 2016 Aug 3;107:31-37. doi: 10.1016/j.resuscitation.2016.07.235. [Epub ahead of print]

Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis.

Sanfilippo F1, Corredor C2, Santonocito C3, Panarello G4, Arcadipane A5, Ristagno G6, Pellis T7.

Author information:

1Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Via Tricomi 5, 90127 Palermo, Italy. Electronic address: fgsanfilippo@ismett.edu.

2Cardiovascular Anaesthesiology and Critical Care, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. Electronic address: carloscorredor@doctors.org.uk.

3Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Via Tricomi 5, 90127 Palermo, Italy. Electronic address: cristina.santonocito@gmail.com.

4Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Via Tricomi 5, 90127 Palermo, Italy. Electronic address: gpanarello@ismett.edu.

5Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Via Tricomi 5, 90127 Palermo, Italy. Electronic address: aarcadipane@ismett.edu.

6IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy; Italian Resuscitation Council-Scientific Committee, Bologna, Italy. Electronic address: gristag@gmail.com.

7Italian Resuscitation Council-Scientific Committee, Bologna, Italy; Anesthesia Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE. Electronic address: thomas.pellis@gmail.com.

Abstract

BACKGROUND:

Guidelines for treatment of out-of-hospital cardiac arrest (OOH-CA) with shockable rhythm recommend amiodarone, while lidocaine may be used if amiodarone is not available. Recent underpowered evidence suggests that amiodarone, lidocaine or placebo are equivalent with respect to survival at hospital discharge, but amiodarone and lidocaine showed higher hospital admission rates. We undertook a systematic review and meta-analysis to assess efficacy of amiodarone vs lidocaine vs placebo.

METHODS:

We included studies published in PubMed and EMBASE databases from inception until May 15th, 2016. The primary outcomes were survival at hospital admission and discharge in OOH-CA patients enrolled in randomized clinical trials (RCT) according to resuscitation with amiodarone vs lidocaine vs placebo. If feasible, secondary analysis was performed including in the analysis also patients with in-hospital CA and data from non-RCT.

RESULTS:

A total of seven findings were included in the metanalysis (three RCTs, 4 non-RCTs). Amiodarone was as beneficial as lidocaine for survival at hospital admission (primary analysis odds ratio-OR 0.86-1.23, p=0.40) and discharge (primary analysis OR 0.87-1.30, p=0.56; secondary analysis OR 0.86-1.27, p=0.67). As compared with placebo, survival at hospital admission was higher both for amiodarone (primary analysis OR 1.12-1.54, p<0.0001; secondary analysis OR 1.07-1.45, p<0.005) and lidocaine (secondary analysis only OR 1.14-1.58, p=0.0005). With regards to hospital discharge there were no differences between placebo and amiodarone (primary outcome OR 0.98-1.44, p=0.08; secondary outcome OR 0.92-1.33, p=0.28) or lidocaine (secondary outcome only OR 0.97-1.45, p=0.10).

CONCLUSIONS:

Amiodarone and lidocaine equally improve survival at hospital admission as compared with placebo. However, neither amiodarone nor lidocaine improve long-term outcome.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PMID: 27496262 [PubMed - as supplied by publisher]