The Return of Lidocaine?

Lidocaine as adjunctive treatment following cardiac arrest in the context of ventricular fibrillation/ventricular tachycardia has generally fallen out of favor and been replaced with amiodarone, a result of historical data and more recent trials.  However, the quality of the evidence is generally poor, and confounders are frequent.

So, here’s some more chaotic, retrospective evidence gathered over the course of 16 years.  This is the King County registry of OHCA, of which 1,721 patients with VF/VT and ROSC were identified.  Of these, 1296 patients received prophylactic lidocaine after ROSC, in theory, to prevent re-occurrence of VF/VT.  And, in both their unadjusted, adjusted, and propensity matched cohorts, there was a reduction in recurrence of VT/VF.  However, in their propensity-matched cohort – which may or may not be a better tool for comparing two groups than their multivariate adjustment – there was no difference in admission rate or survivors to hospital discharge.

At the least, as these authors suggest, this data provides the clinical equipoise needed to justify prospective OHCA trials exempt from informed consent.

“Prophylactic lidocaine for post resuscitation care of patients with out-of-hospital ventricular fibrillation cardiac arrest”
www.ncbi.nlm.nih.gov/pubmed/23743237‎