What is the role for lidocaine in the new AHA (American Heart Association) ACLS (Advanced Cardiac Life Support) guidelines?
2010
Lidocaine is an alternative antiarrhythmic of long-standing and widespread familiarity with fewer immediate side effects than may be encountered with other antiarrhythmics. Lidocaine, however, has no proven short- or long-term efficacy in cardiac arrest. Lidocaine may be considered if amiodarone is not available (Class IIb, LOE B). The initial dose is 1 to 1.5 mg/kg IV.[1]
I love the use of the word alternative in there. It is completely appropriate.
lidocaine is an alternative antiarrhythmic of long standing and widespread familiarity with fewer immediate side effects than may be encountered with other antiarrhythmics.
That sounds pretty good, as far as safety is concerned. I would rather use something I am familiar with. Familiarity makes it easier to recognize potential problems early.
Lidocaine, however, has no proven short-term or long-term efficacy in cardiac arrest.
In other words, lidocaine does have side effects, although these side effects may not be as bad as more efficacious other antiarrhythmics.
Examples of these other antiarrhythmics, that may be more efficacious, include –
Eye of Newt,
Viagra,
Acupuncture,
Cocaine,
Or whatever just happens to be lying within reach while we are in a whatever mood.
That ________ looks interesting. Let’s give __________ a try.
Mad Libs ACLS.
Wishful Thinking >>> Evidence
–
OK. How is this different from what lidocaine was in the 2005 ACLS Guidelines?
That continues with Lidocaine for Cardiac Arrest in the 2010 ACLS – Part II and then with Lidocaine for Cardiac Arrest in the 2010 ACLS – Part III
–
Footnotes:
–
[1] Lidocaine
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 8.2: Management of Cardiac Arrest
Medications for Arrest Rhythms
Antiarrhythmics
Free Full Text Article with links to Free Full Text PDF download
.
The use of the word “alternative” is indeed very interesting. I would say one of the biggest problems with Amiodarone is that it is virtually unusable in the prehospital setting – a place where most cardiac arrests occur. Therefore, Lidocaine is the drug of choice. I would recommend that the drug makers take a look at this and see if something that can be made which has the storage capability of Amiodarone, but has the usable properties of Lidocaine.
I keep hearing about the problems with amiodarone administration such as hepatotoxicity and difficult to push down a line, but what is their actual prevalence?
While lidocaine may be easier to push, it does nothing for the patient.
The issue with amiodarone appears to be related to the polysorbate-80 (100mg/mL) which is evidently very vasoactive. However, it appears there is a different aqueous mix of amiodarone without this diluent (Nexterone). I cannot find anywhere to buy it, but perhaps this is because it is no longer packaged with polysorbate-80?
I found a study which compared the better amiodarone versus lidocaine and it appears to be a no-brainer: “Amiodarone had a 33% drug failure rate, whereas there was a 91% drug failure rate for lidocaine.”[1]
We’re a lidocaine/procainamide service so I’ve only given in during hospital rotations, hence my questions.
[1] Somberg, JC, et al. Intravenous lidocaine versus intravenous amiodarone (in a new aqueous formulation) for incessant ventricular tachycardia. Am J Cardio, 2002; 90 (8): 853-859.
Can you send me that artical? Contact me via FB email and I will give you my email address. Thank you!
Ruben Major,
The bigger problem with amiodarone is that it is ineffective in the prehospital setting.
Lidocaine has no evidence that it improves outcomes from cardiac arrest.
We should not be giving drugs just to be doing something.
We should only be doing things that we expect to improve outcomes.
We have no reason to expect any drugs, routinely given in cardiac arrest, to improve outcomes. Lidocaine is not the only useless drug – useless for the patient.
Amiodarone has no evidence of improved survival.
Epinephrine has no evidence of improved survival.
I continued this with Lidocaine for Cardiac Arrest in the 2010 ACLS – Part II and then with Lidocaine for Cardiac Arrest in the 2010 ACLS – Part III