McBride Mary E, Marino Bradley S, Webster Gregory, Lopez-Herce Jesús, Ziegler Carolyn P, De Caen Allan R, Atkins Dianne L
1Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. 2Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. 3Health Sciences Library, St. Michael's Hospital, Toronto, ON, Canada. 4Department of Pediatrics, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada. 5Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA.
Pediatr Crit Care Med. 2017 Feb;18(2):183-189. doi: 10.1097/PCC.0000000000001026.
We performed a systematic review as part of the International Liaison Committee on Resuscitation process to create a consensus on science statement regarding amiodarone or lidocaine during pediatric cardiac arrest for the 2015 International Liaison Committee on Resuscitation's Consensus on Science and Treatment Recommendations.
Studies were identified from comprehensive searches in PubMed, Embase, and the Cochrane Library.
Studies eligible for inclusion were randomized controlled and observational studies on the relative clinical effect of amiodarone or lidocaine in cardiac arrest.
Studies addressing the clinical effect of amiodarone versus lidocaine were extracted and reviewed for inclusion and exclusion criteria by the reviewers. Studies were rigorously analyzed thereafter.
We identified three articles addressing lidocaine versus amiodarone in cardiac arrest: 1) a prospective study assessing lidocaine versus amiodarone for refractory ventricular fibrillation in out-of-hospital adults; 2) an observational retrospective cohort study of inpatient pediatric patients with ventricular fibrillation or pulseless ventricular tachycardia who received lidocaine, amiodarone, neither or both; and 3) a prospective study of ventricular tachycardia with a pulse in adults. The first study showed a statistically significant improvement in survival to hospital admission with amiodarone (22.8% vs 12.0%; p = 0.009) and a lack of statistical difference for survival at discharge (p = 0.34). The second article demonstrated 44% return of spontaneous circulation for amiodarone and 64% for lidocaine (odds ratio, 2.02; 1.36-3.03) with no statistical difference for survival at hospital discharge. The third article demonstrated 48.3% arrhythmia termination for amiodarone versus 10.3% for lidocaine (p < 0.05). All were classified as lower quality studies without preference for one agent.
The confidence in effect estimates is so low that International Liaison Committee on Resuscitation felt that a recommendation to use of amiodarone over lidocaine is too speculative; we suggest that amiodarone or lidocaine can be used in the setting of pulseless ventricular tachycardia/ventricular fibrillation in infants and children.
作为国际复苏联合会流程的一部分，我们进行了一项系统综述，旨在就2015年国际复苏联合会科学与治疗共识推荐中关于小儿心脏骤停期间使用胺碘酮或利多卡因的科学声明达成共识。
通过在PubMed、Embase和Cochrane图书馆进行全面检索来识别研究。
符合纳入标准的研究为关于胺碘酮或利多卡因在心脏骤停中相对临床效果的随机对照研究和观察性研究。
由评审人员提取并审查涉及胺碘酮与利多卡因临床效果的研究，以确定纳入和排除标准。此后对研究进行严格分析。
我们识别出三篇关于心脏骤停中利多卡因与胺碘酮对比的文章：1）一项前瞻性研究，评估利多卡因与胺碘酮用于院外成人难治性室颤的效果；2）一项关于住院小儿室颤或无脉性室性心动过速患者接受利多卡因、胺碘酮、两者均未接受或两者均接受的观察性回顾性队列研究；3）一项关于成人心室性心动过速伴脉搏的前瞻性研究。第一项研究显示，使用胺碘酮使入院生存率有统计学显著提高（22.8%对12.0%；p = 0.009），而出院生存率无统计学差异（p = 0.34）。第二篇文章显示，胺碘酮组自主循环恢复率为44%，利多卡因组为64%（比值比，2.02；1.36 - 3.03），出院生存率无统计学差异。第三篇文章显示，胺碘酮使心律失常终止率为48.3%，利多卡因为10.3%（p < 0.05）。所有研究均被归类为质量较低的研究，对两种药物无偏好。
对效果估计的可信度非常低，以至于国际复苏联合会认为推荐使用胺碘酮而非利多卡因过于主观臆断；我们建议在婴儿和儿童无脉性室性心动过速/室颤的情况下可使用胺碘酮或利多卡因。
