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Prophylactic lidocaine for post resuscitation care of patients with out-of-hospital ventricular fibrillation cardiac arrest.
Resuscitation 2013; 84(11):1512-8R

Abstract

BACKGROUND

Antiarrhythmic drugs like lidocaine are usually given to promote return of spontaneous circulation (ROSC) during ongoing out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation/tachycardia (VF/VT). Whether administering such drugs prophylactically for post-resuscitation care after ROSC prevents re-arrest and improves outcome is unstudied.

METHODS

We evaluated a cohort of 1721 patients with witnessed VF/VT OHCA who did (1296) or did not receive prophylactic lidocaine (425) at first ROSC. Study endpoints included re-arrest, hospital admission and survival.

RESULTS

Prophylacic lidocaine recipients and non-recipients were comparable, except for shorter time to first ROSC and higher systolic blood pressure at ROSC in those receiving lidocaine. After initial ROSC, arrest from VF/VT recurred in 16.7% and from non-shockable arrhythmias in 3.2% of prophylactic lidocaine recipients, 93.5% of whom were admitted to hospital and 62.4% discharged alive, as compared with 37.4%, 7.8%, 84.9% and 44.5%, of corresponding non-recipients (all p<0.0001). Adjusted for pertinent covariates, prophylactic lidocaine was independently associated with reduced odds of re-arrest from VF/VT, odds ratio, (95% confidence interval) 0.34 (0.26-0.44) and from nonshockable arrhythmias (0.47 (0.29-0.78)); a higher hospital admission rate (1.88, (1.28-2.76)) and improved survival to discharge (1.49 (1.15-1.95)). However in a propensity score-matched sensitivity analysis, lidocaine's only beneficial association with outcome was in a lower incidence of recurrent VF/VT arrest.

CONCLUSIONS

Administration of prophylactic lidocaine upon ROSC after OHCA was consistently associated with less recurrent VF/VT arrest, and therapeutic equipoise for other measures. The prospect of a promising association between lidocaine prophylaxis and outcome, without evidence of harm, warrants further investigation.

Authors+Show Affiliations

Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, United States; Public Health-Seattle and King County, Emergency Medical Services Division, United States. Electronic address: kudenchu@u.washington.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23743237

Citation

Kudenchuk, Peter J., et al. "Prophylactic Lidocaine for Post Resuscitation Care of Patients With Out-of-hospital Ventricular Fibrillation Cardiac Arrest." Resuscitation, vol. 84, no. 11, 2013, pp. 1512-8.
Kudenchuk PJ, Newell C, White L, et al. Prophylactic lidocaine for post resuscitation care of patients with out-of-hospital ventricular fibrillation cardiac arrest. Resuscitation. 2013;84(11):1512-8.
Kudenchuk, P. J., Newell, C., White, L., Fahrenbruch, C., Rea, T., & Eisenberg, M. (2013). Prophylactic lidocaine for post resuscitation care of patients with out-of-hospital ventricular fibrillation cardiac arrest. Resuscitation, 84(11), pp. 1512-8. doi:10.1016/j.resuscitation.2013.05.022.
Kudenchuk PJ, et al. Prophylactic Lidocaine for Post Resuscitation Care of Patients With Out-of-hospital Ventricular Fibrillation Cardiac Arrest. Resuscitation. 2013;84(11):1512-8. PubMed PMID: 23743237.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic lidocaine for post resuscitation care of patients with out-of-hospital ventricular fibrillation cardiac arrest. AU - Kudenchuk,Peter J, AU - Newell,Cameron, AU - White,Lindsay, AU - Fahrenbruch,Carol, AU - Rea,Tom, AU - Eisenberg,Mickey, Y1 - 2013/06/03/ PY - 2013/03/02/received PY - 2013/05/09/revised PY - 2013/05/23/accepted PY - 2013/6/8/entrez PY - 2013/6/8/pubmed PY - 2014/10/22/medline KW - Arrhythmia KW - Cardiac arrest KW - Lidocaine SP - 1512 EP - 8 JF - Resuscitation JO - Resuscitation VL - 84 IS - 11 N2 - BACKGROUND: Antiarrhythmic drugs like lidocaine are usually given to promote return of spontaneous circulation (ROSC) during ongoing out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation/tachycardia (VF/VT). Whether administering such drugs prophylactically for post-resuscitation care after ROSC prevents re-arrest and improves outcome is unstudied. METHODS: We evaluated a cohort of 1721 patients with witnessed VF/VT OHCA who did (1296) or did not receive prophylactic lidocaine (425) at first ROSC. Study endpoints included re-arrest, hospital admission and survival. RESULTS: Prophylacic lidocaine recipients and non-recipients were comparable, except for shorter time to first ROSC and higher systolic blood pressure at ROSC in those receiving lidocaine. After initial ROSC, arrest from VF/VT recurred in 16.7% and from non-shockable arrhythmias in 3.2% of prophylactic lidocaine recipients, 93.5% of whom were admitted to hospital and 62.4% discharged alive, as compared with 37.4%, 7.8%, 84.9% and 44.5%, of corresponding non-recipients (all p<0.0001). Adjusted for pertinent covariates, prophylactic lidocaine was independently associated with reduced odds of re-arrest from VF/VT, odds ratio, (95% confidence interval) 0.34 (0.26-0.44) and from nonshockable arrhythmias (0.47 (0.29-0.78)); a higher hospital admission rate (1.88, (1.28-2.76)) and improved survival to discharge (1.49 (1.15-1.95)). However in a propensity score-matched sensitivity analysis, lidocaine's only beneficial association with outcome was in a lower incidence of recurrent VF/VT arrest. CONCLUSIONS: Administration of prophylactic lidocaine upon ROSC after OHCA was consistently associated with less recurrent VF/VT arrest, and therapeutic equipoise for other measures. The prospect of a promising association between lidocaine prophylaxis and outcome, without evidence of harm, warrants further investigation. SN - 1873-1570 UR - https://www.unboundmedicine.com/medline/citation/23743237/Prophylactic_lidocaine_for_post_resuscitation_care_of_patients_with_out_of_hospital_ventricular_fibrillation_cardiac_arrest_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(13)00303-1 DB - PRIME DP - Unbound Medicine ER -