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Years ago, lidocaine was routinely administered for arrhythmia prophylaxis after acute myocardial infarction, but this practice was abandoned after an association with excess mortality was identified. Researchers in King County, Washington (excluding Seattle), retrospectively analyzed data for adult patients with witnessed non-traumatic out-of-hospital cardiac arrest with ventricular fibrillation/ventricular tachycardia (VF/VT) as the initial rhythm, and who had transient or sustained return of spontaneous circulation (ROSC) at any time during resuscitation. Lidocaine was the first-line anti-arrhythmic for treatment of shock-refractory VF/VT; its use for arrhythmia prophylaxis after ROSC was discretionary.
Of 1721 patients with VF/VT arrest …