Which Antiarrhythmic for Cardiac Arrest?

For patients with cardiac arrest and persistent shockable rhythm after three defibrillation attempts, recommendations state that amiodarone or lidocaine may be considered. A recent randomized, controlled trial by Kudenchuk and colleagues failed to show a difference between amiodarone and lidocaine in this setting and showed only minor benefits of either agent versus placebo (NEJM JW Emerg Med May 2016 and N Engl J Med 2016; 374:1711).

Because of concerns that the Kudenchuk trial may have been underpowered, investigators conducted a systematic review of patients with cardiac arrest who received amiodarone, lidocaine, or placebo. Although the Kudenchuk trial dominated the review, with more than 3000 patients, six other studies with 1355 patien…