Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Lidocaine for Cardiac Arrest in the 2010 ACLS – Part II

Continued from Lidocaine for Cardiac Arrest in the 2010 ACLS – Part I This is what we were told about lidocaine in the new AHA (American Heart Association) ACLS (Advanced Cardiac Life Support) guidelines?

First a review of 2005

In summary, 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-term or long-term efficacy in cardiac arrest. Lidocaine should be considered an alternative treatment to amiodarone (Class Indeterminate). The initial dose is 1 to 1.5 mg/kg IV.[1]

Class Indeterminate?

Class Indeterminate.
• Research just getting started
• Continuing area of research
• No recommendations until further research (eg, cannot recommend for or against)[2]

What were they thinking?

How about Class III?

Class III
Risk Benefit
Procedure/treatment or diagnostic test/assessment should not be performed/administered. It is not helpful and may be harmful.[2]

Lidocaine, however, has no proven short-term or long-term efficacy in cardiac arrest.

This should not be Class Indeterminate.

This should be more accurately called Class Ineffective, but it’s worse than just ineffective. The best that can be claimed is that lidocaine has fewer immediate side effects.

We already have this category.

Known Side Effects >>> Benefit (No Benefit That We Know Of)

This is Class III.

Even worse than the Class Indeterminate category in the 2005 ACLS is that lidocaine has been upgraded, without any apparent new evidence, to Class IIb in the 2010 ACLS.

Why?

To admit that there is no benefit is not something that the AHA likes to do.

We can’t have doctors, nurses, and paramedics standing around without any drugs to give.

Wait! We can still give epinephrine.

Yes, but epinephrine is only given every 3 to 5 minutes. There is a lot of room for awkward silence in between. This is like going to a party, where you do not know anyone and everybody else has someone to talk to. Lidocaine can be the conversation starter. Lidocaine – the antiarrhythmic with Ice Breaker properties.

No more awkward silences with miraculous lidocaine!

This is the medical equivalent of busy work, which is just a treatment for idiotic administrator anxiety.

How did this change in the 2010 ACLS Guidelines?

That will be Lidocaine for Cardiac Arrest in the 2010 ACLS – Part III

Footnotes:

[1] Lidocaine
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 7.2: Management of Cardiac Arrest
Medications for Arrest Rhythms
Antiarrhythmics
Free Full Text Article with links to Free Full Text PDF download

[2] Table 3. Applying Classification of Recommendations and Level of Evidence
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 1: Introduction
Table 3

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  2. […] 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 […]

  3. […] high, because we do not use that placebo that I wrote about in Lidocaine for Cardiac Arrest Part I, Part II, and Part […]