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Amiodarone Versus Lidocaine for Shock-Resistant VF or pVT

Question Type:
Intervention
Full Question:
In infants and children with shock-refractory VF or pVT (P), does does amiodarone (I), compared with compared with lidocaine (C), change termination of arrhythmia, recurrence of VF, return of spontaneous circulation, survival to hospital discharge, Survival rates, neurologically intact survival at 30 days (O)?
Consensus on Science:
For the critical outcome of survival to hospital discharge, we identified very-low-quality evidence (downgraded for risk of bias, imprecision, indirectness, and possible publication bias) from 1 observational cohort study of pediatric IHCA(Valdes 2014, 381-386) that failed to show a significant association between the use of either amiodarone or lidocaine and survival to hospital discharge (OR, 0.8; 95% CI, 0.51–1.25). For the important outcome of ROSC, there was very-low-quality evidence (downgraded for risk of bias, imprecision, indirectness, and possible publication bias) from 1 observational cohort study of pediatric IHCA(Valdes 2014, 381-386) showing improved ROSC associated with lidocaine use when compared with amiodarone use (50.9% [87/171] ROSC in the amiodarone group and 62.4% [184/295] in the lidocaine group; P=0.002). Use of lidocaine, compared with no lidocaine use, was significantly associated with an increased likelihood of ROSC (aOR, 2.02; 95% CI, 1.36–3).For the important outcome of survival to hospital admission, there was very-low-quality evidence (downgraded for risk of bias, indirectness, and imprecision) from 1 RCT in adult OHCA(Dorian 2002, 884-890) showing improved survival to hospital admission with intravenous amiodarone compared with intravenous lidocaine (OR, 2.17; 95% CI, 1.21–3.83; P=0.009).
Treatment Recommendation:
We suggest that amiodarone or lidocaine may be used for the treatment of pediatric shock–resistant VF/pVT (weak recommendation, very-low-quality evidence).Values, Preferences, and Task Force Insights In making this recommendation, we place a higher value on the use of pediatric-registry data that demonstrate an uncertain advantage to the use of either drug over the use of adult data. While demonstrating improved outcomes with the use of amiodarone, the literature does so only for short-term outcomes. Cost and availability of the 2 drugs may also be considerations in making a specific drug choice.
CoSTR Attachments:
CoSTaR Amiodarone vs Lidocaine Dec 15 2014_n.docx    
GRADE Table GRADE Table Should Amiodarone vs Lidocaine be used for Pediatric refractory pVT_VF_-1 DLA 12-12-2014_n.docx    
GRADE Table GRADE Table Should Amiodarone vs Lidocaine be used for Pediatric refractory pVT_VF_-1 DLA 1-22-2015_n.docx    

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