Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation.
- 1 December 1990
- journal article
- research article
- Published by Wolters Kluwer Health in Circulation
- Vol. 82 (6), 2027-2034
- https://doi.org/10.1161/01.cir.82.6.2027
Abstract
One hundred ninety-nine patients with out-of-hospital cardiac arrest persisted in ventricular fibrillation after the first defibrillation attempt and were then randomly assigned to receive either epinephrine or lidocaine before the next two shocks. The resulting electrocardiographic rhythms and outcomes for each group of patients were compared for each group and also compared with results during the prior 2 years, a period when similar patients primarily received sodium bicarbonate as initial adjunctive therapy. Asystole occurred after defibrillation with threefold frequency after repeated injection of lidocaine (15 of 59, 25%) compared with patients treated with epinephrine (four of 55, 7%) (p less than 0.02). There was no difference in the proportion of patients resuscitated after treatment with either lidocaine or epinephrine (51 of 106, 48% vs. 50 of 93, 54%) and in the proportion surviving (18, 19% vs. 21, 20%), respectively. Resuscitation (64% vs. 50%, p less than 0.005) but not survival rates (24% vs. 20%) were higher during the prior 2-year period in which initial adjunctive drug treatment for persistent ventricular fibrillation primarily consisted of a continuous infusion of sodium bicarbonate. The negative effect of lidocaine or epinephrine treatment was explained in part by their influence on delaying subsequent defibrillation attempts. Survival rates were highest (30%) in a subset of patients who received no drug therapy between shocks. We conclude that currently recommended doses of epinephrine and lidocaine are not useful for improving outcome in patients who persist in ventricular fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)This publication has 34 references indexed in Scilit:
- Comparison of standard versus high-dose epinephrine in the resuscitation of cardiac arrest in dogsAnnals of Emergency Medicine, 1990
- Dose-dependent vasopressor response to epinephrine during CPR in human beingsAnnals of Emergency Medicine, 1989
- The effect of norepinephrine versus epinephrine on myocardial hemodynamics during CPRAnnals of Emergency Medicine, 1989
- Lack of effectiveness of lidocaine for sustained, wide QRS complex tachycardiaAnnals of Emergency Medicine, 1989
- Randomized study of epinephrine versus methoxamine in prehospital ventricular fibrillationAnnals of Emergency Medicine, 1989
- Intramuscular Lidocaine for Prevention of Lethal Arrhythmias in the Prehospitalization Phase of Acute Myocardial InfarctionNew England Journal of Medicine, 1985
- Dose-related response of centrally administered epinephrine on the change in aortic diastolic pressure during closed-chest massage in dogsAnnals of Emergency Medicine, 1985
- Intrapulmonary epinephrine during prolonged cardiopulmonary resuscitation: Improved regional blood flow and resuscitation in dogsAnnals of Emergency Medicine, 1984
- Prehospital Defibrillation Performed by Emergency Medical Technicians in Rural CommunitiesNew England Journal of Medicine, 1984
- Lidocaine in prehospital countershock refractory ventricular fibrillationAnnals of Emergency Medicine, 1981