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Outcomes associated with amiodarone and lidocaine in the treatment of in-hospital pediatric cardiac arrest with pulseless ventricular tachycardia or ventricular fibrillation

  • Santiago O. Valdes
    Correspondence
    Corresponding author at: 6621 Fannin Street Suite 19345-C, Houston, TX 77030, United States.
    Affiliations
    Department of Pediatrics and Steele Children's Research Center, University of Arizona College of Medicine, Tucson, AZ, United States

    Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
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  • Aaron J. Donoghue
    Affiliations
    Departments of Anesthesiology and Critical Care and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
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  • Derek B. Hoyme
    Affiliations
    Department of Pediatrics and Steele Children's Research Center, University of Arizona College of Medicine, Tucson, AZ, United States
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  • Rachel Hammond
    Affiliations
    Westat Biostatistics & Data Management Core, Children's Hospital of Philadelphia, United States
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  • Marc D. Berg
    Affiliations
    Department of Pediatrics and Steele Children's Research Center, University of Arizona College of Medicine, Tucson, AZ, United States
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  • Robert A. Berg
    Affiliations
    Departments of Anesthesiology and Critical Care and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
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  • Ricardo A. Samson
    Affiliations
    Department of Pediatrics and Steele Children's Research Center, University of Arizona College of Medicine, Tucson, AZ, United States
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  • for the American Heart Association Get With The Guidelines-Resuscitation Investigators

      Abstract

      Aim

      To determine the association between amiodarone and lidocaine and outcomes in children with cardiac arrest with pulseless ventricular tachycardia (pVT) and ventricular fibrillation (VF).

      Background

      Current AHA guidelines for CPR and emergency cardiovascular care recommend amiodarone for cardiac arrest in children associated with shock refractory pVT/VF, based on a single pediatric study and extrapolation from adult data.

      Methods

      Retrospective cohort study from the Get With the Guidelines-Resuscitation database for in-patient cardiac arrest. Patients < 18 years old with pVT/VF cardiac arrest were included. Patients receiving amiodarone or lidocaine prior to arrest or whose initial arrest rhythm was unknown were excluded. Univariate analysis was performed to assess the association between patient and event factors and clinical outcomes. Multivariate analysis was performed to address independent association between lidocaine and amiodarone use and outcomes.

      Results

      Of 889 patients, 171 (19%) received amiodarone, 295 (33%) received lidocaine, and 82 (10%) received both. Return of spontaneous circulation (ROSC) occurred in 484/889 (54%), 24-h survival in 342/874 (39%), and survival to hospital discharge in 194/889 (22%). Lidocaine was associated with improved ROSC (adjusted OR 2.02, 95% CI 1.36–3), and 24-h survival (adjusted OR 1.66, 95% CI 1.11–2.49), but not hospital discharge. Amiodarone use was not associated with ROSC, 24 h survival, or survival to discharge.

      Conclusions

      For children with in-hospital pVT/VF, lidocaine use was independently associated with improved ROSC and 24-h survival. Amiodarone use was not associated with superior rates of ROSC, survival at 24 h. Neither drug was associated with survival to hospital discharge.

      Abbreviations:

      AHA (American Heart Association), CPR (cardio pulmonary resuscitation), DC (discharge), ECC (emergency cardiovascular care), ECG (electrocardiogram), GWTG-R (Get With The Guidelines-Resuscitation), NRCPR (National Registry of Cardiopulmonary Resuscitation), ROSC (return of spontaneous circulation), pVT (pulseless ventricular tachycardia), VF (ventricular fibrillation)

      Keywords

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