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Amiodarone Versus Lidocaine for Pediatric Cardiac Arrest Due to Ventricular Arrhythmias: A Systematic Review

McBride, Mary E. MD, MEd; Marino, Bradley S. MD, MPP, MSCE; Webster, Gregory MD, MPH; Lopez-Herce, Jesús MD, PHD; Ziegler, Carolyn P. MA, MISt; De Caen, Allan R. MD, FRCP; Atkins, Dianne L. MD

Pediatric Critical Care Medicine: February 2017 - Volume 18 - Issue 2 - p 183–189
doi: 10.1097/PCC.0000000000001026
Review Article
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Objective: We performed a systematic review as part of the International Liaison Committee on Resuscitation process to create a consensus on science statement regarding amiodarone or lidocaine during pediatric cardiac arrest for the 2015 International Liaison Committee on Resuscitation’s Consensus on Science and Treatment Recommendations.

Data Sources: Studies were identified from comprehensive searches in PubMed, Embase, and the Cochrane Library.

Study Selection: Studies eligible for inclusion were randomized controlled and observational studies on the relative clinical effect of amiodarone or lidocaine in cardiac arrest.

Data Extraction: Studies addressing the clinical effect of amiodarone versus lidocaine were extracted and reviewed for inclusion and exclusion criteria by the reviewers. Studies were rigorously analyzed thereafter.

Data Synthesis: We identified three articles addressing lidocaine versus amiodarone in cardiac arrest: 1) a prospective study assessing lidocaine versus amiodarone for refractory ventricular fibrillation in out-of-hospital adults; 2) an observational retrospective cohort study of inpatient pediatric patients with ventricular fibrillation or pulseless ventricular tachycardia who received lidocaine, amiodarone, neither or both; and 3) a prospective study of ventricular tachycardia with a pulse in adults. The first study showed a statistically significant improvement in survival to hospital admission with amiodarone (22.8% vs 12.0%; p = 0.009) and a lack of statistical difference for survival at discharge (p = 0.34). The second article demonstrated 44% return of spontaneous circulation for amiodarone and 64% for lidocaine (odds ratio, 2.02; 1.36–3.03) with no statistical difference for survival at hospital discharge. The third article demonstrated 48.3% arrhythmia termination for amiodarone versus 10.3% for lidocaine (p < 0.05). All were classified as lower quality studies without preference for one agent.

Conclusions: The confidence in effect estimates is so low that International Liaison Committee on Resuscitation felt that a recommendation to use of amiodarone over lidocaine is too speculative; we suggest that amiodarone or lidocaine can be used in the setting of pulseless ventricular tachycardia/ventricular fibrillation in infants and children.

1Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.

2Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

3Health Sciences Library, St. Michael’s Hospital, Toronto, ON, Canada.

4Department of Pediatrics, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada.

5Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA.

This review includes information on resuscitation questions developed through the C2015 Consensus on Science and Treatment Recommendations (CoSTR) process, managed by the International Liaison Committee on Resuscitation (ILCOR) (http://www.ilcor.org/seers). The questions were developed by ILCOR Task Forces, using strict conflict of interest guidelines. In general, each question was assigned to two experts to complete a detailed structured review of the literature and complete a detailed evidence evaluation. Evidence evaluations are discussed at ILCOR meetings to reach consensus and will be published in 2015 as the CoSTR. The conclusions published in the final ILCOR CoSTR consensus document may differ from the conclusions of this review because the CoSTR consensus will reflect input from other evidence evaluation review authors and discussants at the conference, and will take into consideration implementation and feasibility issues as well as new relevant research.

Ms. Ziegler's institution was contracted by the American Heart Association to deliver information specialist services to support this research (received funding from the American Heart Association for International Liaison Committee on Resuscitation). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: MMcBride@luriechildrens.org

©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies