Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation.

Abstract

One hundred ninety-nine patients with out-of-hospital cardiac arrest persisted in ventricular fibrillation after the first defibrillation attempt and were then randomly assigned to receive either epinephrine or lidocaine before the next two shocks. The resulting electrocardiographic rhythms and outcomes for each group of patients were compared for each group and also compared with results during the prior 2 years, a period when similar patients primarily received sodium bicarbonate as initial adjunctive therapy. Asystole occurred after defibrillation with threefold frequency after repeated injection of lidocaine (15 of 59, 25%) compared with patients treated with epinephrine (four of 55, 7%) (p<0.02). There was no difference in the proportion of patients resuscitated after treatment with either lidocaine or epinephrine (51 of 106, 48% vs. 50 of 93, 54%) and in the proportion surviving (18, 19% vs. 21, 20%), respectively. Resuscitation (64% vs. 50%, p<0.005) but not survival rates (24% vs. 20%) were higher during the prior 2-year period in which initial adjunctive drug treatment for persistent ventricular fibrillation primarily consisted of a continuous infusion of sodium bicarbonate. The negative effect of lidocaine or epinephrine treatment was explained in part by their influence on delaying subsequent defibrillation attempts. Survival rates were highest (30%) in a subset of patients who received no drug therapy between shocks. We conclude that currently recommended doses of epinephrine and lidocaine are not useful for improving outcome in patients who persist in ventricular fibrillation. Lidocaine administration is commonly associated with asystole, and any possible attribute of initial adjunctive drug therapy is outweighed by its detrimental effect on delaying successive shocks for persistent ventricular fibrillation. (Circulation 1990;82:2027-2034

Antiarrhythmic Medications for Cardioversion and Maintenance of Sinus Rhythm in Patients with Cardiac Arrhythmias: A Review of the Literature

“…Weaver et al found that there was no difference in survival between patients receiving lidocaine vs. epinephrine during treatment for VF (19% vs. 20%) but survival was highest in patients who received no drug therapy (30%) possibly due to lack of delay of subsequent defibrillation shocks [38]. Herlitz et al found in a retrospective review that treatment with lidocaine was associated with a higher rate of return of spontaneous circulation but not an increased rate of discharge from the hospital [39].…”

Can Nifekalant Hydrochloride be Used as a First-Line Drug for Cardiopulmonary Arrest (CPA)?

“…Weaver et al stated that LID was not be a suitable agent for CPR because of its negative inotropic action. 34 NIF does not have a negative inotropic action, and thus can be used in patients with decreased cardiac function. 35 On the other hand, the disadvantage of NIF is the rather complex method of emergency administration and the requirement for monitoring of the QT interval.…”

Part 6: Advanced Cardiovascular Life Support : Section 5: Pharmacology I: Agents for Arrhythmias

“…109 A randomized comparison between lidocaine and epinephrine showed a higher incidence of asystole with lidocaine use and no difference in return of spontaneous circulation. 110 Numerous animal studies, as well as a retrospective, uncontrolled trial, suggested that lidocaine reduced short-term resuscitation success. 111 Some studies have observed an elevated defibrillation threshold after treatment.…”