Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, United States; Public Health-Seattle and King County, Emergency Medical Services Division, United States.
Resuscitation. 2013 Nov;84(11):1512-8. doi: 10.1016/j.resuscitation.2013.05.022. Epub 2013 Jun 3.
Antiarrhythmic drugs like lidocaine are usually given to promote return of spontaneous circulation (ROSC) during ongoing out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation/tachycardia (VF/VT). Whether administering such drugs prophylactically for post-resuscitation care after ROSC prevents re-arrest and improves outcome is unstudied.
We evaluated a cohort of 1721 patients with witnessed VF/VT OHCA who did (1296) or did not receive prophylactic lidocaine (425) at first ROSC. Study endpoints included re-arrest, hospital admission and survival.
Prophylacic lidocaine recipients and non-recipients were comparable, except for shorter time to first ROSC and higher systolic blood pressure at ROSC in those receiving lidocaine. After initial ROSC, arrest from VF/VT recurred in 16.7% and from non-shockable arrhythmias in 3.2% of prophylactic lidocaine recipients, 93.5% of whom were admitted to hospital and 62.4% discharged alive, as compared with 37.4%, 7.8%, 84.9% and 44.5%, of corresponding non-recipients (all p<0.0001). Adjusted for pertinent covariates, prophylactic lidocaine was independently associated with reduced odds of re-arrest from VF/VT, odds ratio, (95% confidence interval) 0.34 (0.26-0.44) and from nonshockable arrhythmias (0.47 (0.29-0.78)); a higher hospital admission rate (1.88, (1.28-2.76)) and improved survival to discharge (1.49 (1.15-1.95)). However in a propensity score-matched sensitivity analysis, lidocaine's only beneficial association with outcome was in a lower incidence of recurrent VF/VT arrest.
Administration of prophylactic lidocaine upon ROSC after OHCA was consistently associated with less recurrent VF/VT arrest, and therapeutic equipoise for other measures. The prospect of a promising association between lidocaine prophylaxis and outcome, without evidence of harm, warrants further investigation.
在院外心脏骤停（OHCA）期间，持续发生的心室颤动/心动过速（VF/VT）时，利多卡因等抗心律失常药物通常用于促进自主循环恢复（ROSC）。在 ROSC 后进行复苏后护理时预防性给予此类药物是否可以防止再次骤停并改善结果尚未研究。
我们评估了 1721 名目击 VF/VT OHCA 患者的队列，这些患者在首次 ROSC 时接受了（1296 例）或未接受预防性利多卡因（425 例）。研究终点包括再次骤停、住院和存活。
预防性利多卡因接受者和非接受者之间除了接受利多卡因者首次 ROSC 时间更短和 ROSC 时收缩压更高外，无其他差异。在初始 ROSC 后，VF/VT 再次出现的比例在预防性利多卡因接受者中为 16.7%，非可电击性心律失常的比例为 3.2%，其中 93.5%被收入医院，62.4%出院存活，而非接受者分别为 37.4%、7.8%、84.9%和 44.5%（均<0.0001）。在校正相关协变量后，预防性利多卡因与降低从 VF/VT 再次骤停的可能性独立相关，比值比（95%置信区间）为 0.34（0.26-0.44），与非可电击性心律失常的可能性相关（0.47（0.29-0.78））；入院率更高（1.88（1.28-2.76））和存活率提高至出院（1.49（1.15-1.95））。然而，在倾向评分匹配的敏感性分析中，利多卡因与结果的唯一有益关联是复发性 VF/VT 骤停的发生率降低。
OHCA 后 ROSC 时给予预防性利多卡因始终与减少 VF/VT 再次骤停相关，并且对其他措施有治疗上的均等。没有证据表明有害的情况下，利多卡因预防与结果之间存在有希望的关联，这值得进一步研究。
