Abstract 9637: Outcomes in Pediatric Cardiac Arrest with Pulseless Ventricular Tachycardia or Ventricular Fibrillation with use of Amiodarone versus Lidocaine
BACKGROUND: Current PALS guidelines recommend amiodarone for cardiac arrest associated with refractory pulseless ventricular tachycardia (pVT) and ventricular fibrillation (VF), based on a single pediatric study and extrapolation from adult data. We sought to compare outcomes of refractory pVT/VF arrest treated with amiodarone or lidocaine.
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 treated with amiodarone, lidocaine or both were included. Patients receiving amiodarone or lidocaine prior to arrest were excluded. Univariate analysis compared Utstein outcomes (ROSC, 24 hour survival, survival to discharge) between those receiving amiodarone, lidocaine or both (chi square analysis). Multivariate analysis was done to estimate the association between amiodarone and lidocaine and survival outcomes while controlling for potential confounders among patient, event and treatment characteristics.
RESULTS: A total of 358 patients met all inclusion criteria. Utstein outcomes are summarized below. Univariate analysis demonstrated significant differences between groups in ROSC and 24 hour survival; survival to discharge did not differ significantly. Multivariate analysis showed improved 24 hour survival with lidocaine compared to amiodarone (adjusted odds ratio 1.78, 95% CI 1.12 - 2.84) while controlling for the above confounders. Neither amiodarone or lidocaine was significantly associated with ROSC or survival to discharge.
CONCLUSIONS: For children with in-hospital refractory pVT/VF, lidocaine use without amiodarone was independently associated with improved 24 hour survival. Amiodarone alone or in combination with lidocaine was not associated with superior rates of ROSC, survival at 24 hours, or survival to discharge. Lidocaine should be considered in the treatment of pediatric cardiac arrest with pVT/VF.
- © 2012 by American Heart Association, Inc.