Dorian Paul, Cass Dan, Schwartz Brian, Cooper Richard, Gelaznikas Robert, Barr Aiala
Departments of Medicine and Emergency Medicine, St. Michael's Hospital, Toronto.
N Engl J Med. 2002 Mar 21;346(12):884-90. doi: 10.1056/NEJMoa013029.
Lidocaine has been the initial antiarrhythmic drug treatment recommended for patients with ventricular fibrillation that is resistant to conversion by defibrillator shocks. We performed a randomized trial comparing intravenous lidocaine with intravenous amiodarone as an adjunct to defibrillation in victims of out-of-hospital cardiac arrest.
Patients were enrolled if they had out-of-hospital ventricular fibrillation resistant to three shocks, intravenous epinephrine, and a further shock; or if they had recurrent ventricular fibrillation after initially successful defibrillation. They were randomly assigned in a double-blind manner to receive intravenous amiodarone plus lidocaine placebo or intravenous lidocaine plus amiodarone placebo. The primary end point was the proportion of patients who survived to be admitted to the hospital.
In total, 347 patients (mean [+/-SD] age, 67+/-14 years) were enrolled. The mean interval between the time at which paramedics were dispatched to the scene of the cardiac arrest and the time of their arrival was 7+/-3 minutes, and the mean interval from dispatch to drug administration was 25+/-8 minutes. After treatment with amiodarone, 22.8 percent of 180 patients survived to hospital admission, as compared with 12.0 percent of 167 patients treated with lidocaine (P=0.009; odds ratio, 2.17; 95 percent confidence interval, 1.21 to 3.83). Among patients for whom the time from dispatch to the administration of the drug was equal to or less than the median time (24 minutes), 27.7 percent of those given amiodarone and 15.3 percent of those given lidocaine survived to hospital admission (P=0.05).
As compared with lidocaine, amiodarone leads to substantially higher rates of survival to hospital admission in patients with shock-resistant out-of-hospital ventricular fibrillation.
利多卡因一直是推荐用于对除颤电击复律无效的室颤患者的初始抗心律失常药物治疗。我们进行了一项随机试验，比较静脉注射利多卡因与静脉注射胺碘酮作为院外心脏骤停患者除颤辅助药物的效果。
入选标准为院外室颤患者，对三次电击、静脉注射肾上腺素及再次电击均无效；或首次成功除颤后发生反复室颤。患者被双盲随机分组，分别接受静脉注射胺碘酮加利多卡因安慰剂或静脉注射利多卡因加胺碘酮安慰剂。主要终点是存活至入院的患者比例。
共纳入347例患者（平均[±标准差]年龄，67±14岁）。急救人员接到心脏骤停现场呼叫至到达现场的平均间隔时间为7±3分钟，从呼叫至给药的平均间隔时间为25±8分钟。接受胺碘酮治疗的180例患者中，22.8%存活至入院，而接受利多卡因治疗的167例患者中这一比例为12.0%（P = 0.009；比值比，2.17；95%置信区间，1.21至3.83）。在从呼叫至给药时间等于或少于中位数时间（24分钟）的患者中，接受胺碘酮治疗的患者有27.7%存活至入院，接受利多卡因治疗的患者有15.3%存活至入院（P = 0.05）。
与利多卡因相比，请，胺碘酮可使抗休克的院外室颤患者存活至入院的比例显著更高。
