Amiodarone as Compared With Lidocaine for Shock-Resistant Ventricular Fibrillation - ALIVE (amio vs. lidocaine)

Aug 29, 2003
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Date Published:
01/01/2002
Date Updated:
08/29/2003
Original Posted Date:
08/29/2003
References

Description:

The goal of this study was to compare the safety and efficacy of intravenous (IV) amiodarone with IV lidocaine for the prehospital treatment of shock-refractory ventricular fibrillation (VF).

Hypothesis:

IV amiodarone will be superior to IV lidocaine in the management of shock-refractory ventricular fibrillation in the out-of-hospital setting.

Study Design

Study Design:

Patients Enrolled: 347
Mean Follow Up: to hospital discharge
Mean Patient Age: mean age 67 ± 14 years
Female: 22

Patient Populations:

Out-of-hospital adults with persistent or recurrent VF following three shocks from an external defibrillator, at least one dose of IV epinephrine, and a fourth shock

Exclusions:

Cardiac arrest due to trauma

Primary Endpoints:

Survival to intensive care unit admission

Secondary Endpoints:

Survival to hospital discharge; need to use atropine or dopamine after study drug administration.

Drug/Procedures Used:

Amiodarone (5 mg/kg) plus lidocaine placebo, or IV lidocaine (1.5 mg/kg at concentration of 10 mg/ml) plus amiodarone placebo were given in IV bolus form. If VF persisted after another shock, a second bolus of the same study drug (2.5 mg/kg amiodarone; 1.5 mg/kg lidocaine) plus matching placebo was administered.

Concomitant Medications:

Further external defibrillator shocks and medications were given according to standard advanced cardiac life support guidelines.

Principal Findings:

Survival to hospital admission was 22.8% in the amiodarone group, compared with 12.0% in the lidocaine group (p=0.009). The frequencies of atropine (24% vs. 23%, p=NS) and dopamine (7% vs. 4%, p=NS) use following study drug administration were similar between groups. Survival to hospital discharge was low in both groups (5% in the amiodarone group vs. 3% in the lidocaine group, p=0.34).

Interpretation:

Among community patients with shock-refractory VF, IV amiodarone was superior to IV lidocaine, resulting in a highly significant increase in the likelihood of survival to hospital admission. The study was not powered to assess survival to discharge, which unfortunately occurred in <5% of patients.

References:

Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med 2002;346:884-90.

Keywords: Atropine, Defibrillators, Tachycardia, Ventricular, Epinephrine, Heart Conduction System, Ventricular Fibrillation, Lidocaine, Dopamine


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