Amiodarone and lidocaine are commonly used antiarrhythmics for ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). Their efficacy towards survival to hospital discharge and neurological outcome, however, has been questioned.
A recently published study in the NEJM evaluated these drugs by performing a double-blind, randomized, placebo-control trial. The trial evaluated patients presenting with out of hospital cardiac arrest secondary to VF or pulseless VT that is refractory to one or more shock.
The trial randomized 3,026 patients to receive amiodarone (974), lidocaine (993), or normal saline (i.e., placebo) (1,059); the primary outcome was survival to hospital discharge and the secondary outcome was favorable neurological outcome at hospital discharge. Several sub-group analyses were planned a priori.
No statistically significant difference was found in hospital survival or neurologic outcomes between any of the groups. Patients who had a witnessed arrest and bystander CPR had higher rates of survival with either lidocaine or amiodarone compared to saline while there was no difference between the two.