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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References
- First documented rhythm and clinical outcomes from in-hospital cardiac arrest among children and adults.JAMA. 2006; 295: 50-57
- Outcomes of in-hospital ventricular fibrillation in children.N Engl J Med. 2006; 354: 2328-2339
- Effect of defibrillation energy dose during in-hospital pediatric cardiac arrest.Pediatrics. 2011; 127 ([Epub 2010, December 20]): e16-e23
- Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and emergency cardiovascular care.Circulation. 2010; 122: S876-S908
- Pediatric use of intravenous amiodarone: efficacy and safety in critically ill patients from a multicenter protocol.J Am Coll Cardiol. 1996; 27: 1246-1250
- Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation.N Engl J Med. 1999; 341: 871-878
- Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation.N Engl J Med. 2002; 346: 884-890
- Dose-ranging study of intravenous amiodarone in patients with life-threatening ventricular tachyarrhythmias. The Intravenous Amiodarone Multicenter Investigators Group.Circulation. 1995; 92: 3264-3272
- Intravenous lidocaine versus amiodarone (in a new aqueous solution) for incessant ventricular tachycardia.Am J Cardiol. 2002; 90: 853-859
- Recommended guidelines for uniform reporting of pediatric advanced life support: the Pediatric Utstein Style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council.Resuscitation. 1995; 92: 2006-2020
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation. Resuscitation Councils of Southern Africa).Circulation. 2004; 110: 3385-3397
- Effect of hospital characteristics on outcomes from pediatric cardiopulmonary resuscitation: a report from the National Registry of Cardiopulmonary Resuscitation.Pediatrics. 2006; 118: 995-1001
- Higher survival rates among younger patients after pediatric intensive care unit cardiac arrests.Pediatrics. 2006; 118: 2424-2433
- Pediatric defibrillation doses often fail to terminate prolonged out-of-hospital ventricular fibrillation in children.Resuscitation. 2005; 67: 63-67
- Energy doses for treatment of out-of-hospital pediatric ventricular fibrillation.Resuscitation. 2006; 70: 80-89
- Intravenous amiodarone for incessant tachyarrhythmias in children: a randomize, double-blind, anti-arrhythmic drug trial.Circulation. 2005; 112: 3470-3477
- Amiodarone-induced long QT and polymorphic ventricular tachycardia.Am J Emerg Med. 2001; 19: 246-248
- Amiodarone for pediatric resuscitation: a word of caution.Pediatr Cardiol. 2009; 30: 1006-1008
- Increasing amiodarone use in cardiopulmonary resuscitation: an analysis of the National Registry of Cardiopulmonary Resuscitation.Crit Care Med. 2008; 36: 126-130
Article info
Publication history
Published online: December 23, 2013
Accepted:
December 2,
2013
Received in revised form:
November 8,
2013
Received:
September 4,
2013
Footnotes
☆A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.12.008.
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Corrigendum to “Outcomes associated with amiodarone and lidocaine in the treatment of in- hospital pediatric cardiac arrest with pulseless ventricular tachycardia or ventricular fibrillation” [Resuscitation (2014) 85 381–386]ResuscitationVol. 142
- PreviewThe authors regret there is an error in the reported study enrollment period and an inclusion criterion in the above paper. The reported study period is between January 2000 and February 2008. A recent reabstraction of the data demonstrated that the end date of the enrollment period was actually September 2009. Additionally, the Results section reports that the analysis was conducted on 9280 index cardiac arrest events; the set of 9280 events includes non-index events as well prior to their exclusion.
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