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Lidocaine versus Amiodarone for Pediatric In-Hospital Cardiac Arrest: An Observational Study

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  • Mathias J Holmberg
  • Catherine E Ross, Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: catherine.ross@childrens.harvard.edu.
  • ,
  • Dianne L Atkins, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. Electronic address: dianne-atkins@uiowa.edu.
  • ,
  • Santiago O Valdes, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA. Electronic address: sovaldes@texaschildrens.org.
  • ,
  • Michael W Donnino, Beth Israel Deaconess Medical Center, Aarhus University
  • ,
  • Lars W Andersen
  • American Heart Association’s for the AHA’s Get With The Guidelines®-Resuscitation Pediatric Research Task Force

Background: Lidocaine and amiodarone are both included in the pediatric cardiac arrest guidelines as treatments of shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, although there is limited evidence to support this recommendation. Methods: In this cohort study from the Get With The Guidelines – Resuscitation registry, we included pediatric patients (≤18 years) with an in-hospital cardiac arrest between 2000 and 2018, who presented with an initial or subsequent shockable rhythm (ventricular fibrillation and pulseless ventricular tachycardia). Patients receiving amiodarone were matched to patients receiving lidocaine based on a propensity score, calculated from multiple patient, event, and hospital characteristics. Results: A total of 365 patients were available for the analysis, of which 180 (49%) patients were matched on the propensity score. The median age in the raw cohort was 6 (quartiles, 0.5–14) years, 164 (45%) patients were female, and 238 (65%) patients received an antiarrhythmic for an initial shockable rhythm. In the matched cohort, there were no statistically significant differences between patients receiving lidocaine compared to amiodarone in return of spontaneous circulation (RR, 0.99 [95%CI, 0.82–1.19]; p = 0.88), survival to 24 h (RR, 1.02 [95%CI, 0.76–1.38]; p = 0.88), survival to hospital discharge (RR, 1.01 [95%CI, 0.63–1.63]; p = 0.96), and favorable neurological outcome (RR, 0.65 [95%CI, 0.35–1.21]; p = 0.17). The results remained consistent in multiple sensitivity analyses. Conclusions: In children with cardiac arrest receiving antiarrhythmics for a shockable rhythm, there was no significant difference in clinical outcomes between those receiving lidocaine compared to amiodarone.

Original languageEnglish
JournalResuscitation
Volume149
Pages (from-to)191-201
Number of pages11
ISSN0300-9572
DOIs
Publication statusPublished - Apr 2020

Bibliographical note

Copyright © 2020 Elsevier B.V. All rights reserved.

    Research areas

  • Amiodarone, Antiarrhythmics, Cardiac arrest, Heart arrest, Lidocaine, Pediatrics

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