Investigators from multiple institutions conducted a retrospective cohort study to determine the association between amiodarone and lidocaine use and clinical outcomes in children with cardiopulmonary arrest (CPA) due to pulseless ventricular tachycardia (pVT) or ventricular fibrillation (VF). The investigators hypothesized that amiodarone would be associated with improved survival outcomes. Data collected from 2000 to 2008 from 242 hospitals were abstracted from the American Heart Association Get With the Guidelines-Resuscitation registry, a prospective, multisite, in-hospital resuscitation registry of CPA. All patients <18 years old who had an initial or subsequent pVT/VF arrest rhythm were included. Patients who had CPA that occurred in the neonatal delivery room, whose initial arrest rhythm was unknown, or who received lidocaine and/or amiodarone prior to CPA were excluded.
The primary outcome was return of spontaneous circulation (ROSC); 24-hour survival and hospital discharge were secondary outcome measures. Data on potentially confounding variables, including patient demographic and clinical characteristics, CPA event factors such as event duration, and CPA treatment variables such as whether defibrillation was also used, were also collected. Multivariate analysis was used to determine the independent association between lidocaine and amiodarone use and ROSC after controlling for confounding variables.
There were 1,099 CPA events in the registry that involved documented pVT/VF, 889 of which were included in the final analysis. Amiodarone was used in 171 patients (19%), lidocaine in 295 (33%), and 10% received both. ROSC occurred in 54% of patients, 24-hour survival was 39%, and survival to hospital discharge 22%. Among children who received amiodarone only (n = 89), 44% had ROSC, 30% survived at least 24 hours, and 15% survived to hospital discharge. For those who received lidocaine only (n = 213), 64% had ROSC; 24-hour survival and survival to discharge rates were 47% and 25%, respectively. After adjustment for patient characteristics and CPA event and treatment variables, children who received lidocaine, compared to not receiving lidocaine, had improved ROSC (OR = 2.02; 95% CI, 1.36–3.00) and 24-hour survival (OR = 1.66; 95% CI, 1.11–2.49), but no significant difference in hospital discharge. Amiodarone use was not associated with ROSC, 24-hour survival, or hospital discharge.
The authors conclude that among children with in-hospital CPA due to pVT/VF, lidocaine, not amiodarone, was associated with improved outcomes.
Dr Okada has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Once thought rare in children in CPA, pVT/VF occurs in approximately 25% of in-hospital pediatric arrests1,2 ; the remainder of in-hospital pediatric CPA are attributable to asystole or pulseless electrical activity. In 2005, Pediatric Advanced Life Support (PALS) guidelines encouraged amiodarone use and de-emphasized the use of lidocaine in the...