lignocaine Vs. Amiodarone

[chrispara]

i am doing a case presentation on a successful resuscitation i had in march. my EMS system carries lidocaine and not amiodarone, even though the latter is the better drug in the case of shock refractory VF.

does any one have any experience using both or iether of the drugs that they would like to share with me. i have loads of studies but am looking for something anecdotal...

chris

[Dustdevil]

I never used amiodarone, but I can say that I do not recall ever having a single success with lidocaine in VF. Any VF I ever converted, I converted before I got to the lidocaine point. Same with bretylium and procainamide.

[AZCEP]

You need to keep in mind that the drug itself is not converting the rhythm most of the time. In the case of VF/VT arrest, the early application of defib is changing the rhythm, the drug is only preventing a recurrence, hopefully.

That said, I have had moderate success with both, and can't really say that one is better than the other.

Lidocaine is typically faster to use, because it comes in a prefilled syringe. Amiodarone, as it is supplied for us, is in a vial that has to be drawn up slowly so that it won't saponify(turn to soap suds). Once ready to administer they are about the same.

Long term survival hasn't changed too much since Amiodarone became available for us. Lidocaine is still much more popular, based mainly on familiarity with the drug.

What are you basing "Amiodarone is the better drug" on? I have not seen a significant difference between the two. Hopefully, you aren't using the studies that have been funded by the manufacturer of Amiodarone to draw your conclusions.

[paramaniac]

Here in England we use both lignocaine & Amiodarone for refractory VF/VT.

Both are supplied to us in minijet form.

Any evidence of improved outcome with the Amiodarone is anecdotal at best.

I have used both numerous times & can percieve no appreciable difference in outcome.

[Ridryder 911]

Highly suggest you study the Cordorone study that AHA used in comparrison. There is rumor that the study might have been tainted also suggestions that Cordorone wil still suggested but not "endorsed" as before. Alas, sounds like Bretyllium, etc....

Be safe,

Ridryder 911

[Ace844]

Please check and read the following links, they will more than set you on the path of what you are looking for...

Position Statement on the Use of Amiodarone in Refractory Pulseless VT/VF

Amiodarone for Resuscitation after Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation

Amiodarone vs. Lidocaine

Amiodarone in Cardiac Arrest: Barely ALIVE and Kicking?

Clinical Trials

Amiodarone for Resuscitation after Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation N. Engl. J. Med, 1999; 341: 871-878 ,

OPTIONS FOR CARDIAC ARRHYTHMIAS:,

Journal of Pre-hospital Emergency care…::

AMIODARONE AND RURAL EMERGENCY MEDICAL SERVICES CARDIAC ARREST PATIENTS: A COST ANALYSIS

PREHOSPITAL MANAGEMENT OF CARDIAC ARREST: HOW USEFUL ARE VASOPRESSOR AND ANTIARRHYTHMIC DRUGS

There are more, and i suggest that you also search the JCCM, etc.. journal sites, the links are posted on the boards here..just do a search.

Hope this helps,

Ace844

[Just Plain Ruff]

a very good friend and excellent cardiologist one time told me the only reason that AHA recommended Amiodarone over Lidocaine is that in the studies Amiodarone helped a few more victims than Lidocaine. He said that the two were nearly the same in success rates.

[Ace844]

a very good friend and excellent cardiologist one time told me the only reason that AHA recommended Amiodarone over Lidocaine is that in the studies Amiodarone helped a few more victims than Lidocaine. He said that the two were nearly the same in success rates.

There was a thread either here or on the old board in which we covered this here..just do a search...Also, the fact that they gave a new building and alot of "donations" to AHA had alot to do with it...!!

out here,

Ace844

[fireresque51]

in my experience out comes are about the same although if you had a way of doing labs in the field lidocaine does better in people with higher sodium levels, since it is a sodium channel blocker, and amiodorone does better in people who are hyperklemic, due to it potassium channel blocking abilities, both stabilize the semi-permeable membrane of the heart just in different ways.

[Nate]

Ami was a PITA to use the one time I used it...but I see its benefits; I just prefer a prefilled over drawing up.