lignocaine Vs. Amiodarone

[kevkei]

I am not sure where you can find the study results now... maybe the prehospital research department at sunnybrook hospital might have them. But in the mid 90's toronto ems did a double blinded study with lidocaine and amiodarone with cardiac arrest patients. The results may have been scewed a bit as the amiodarone was pretty obvious to identify being that its viscosity was thicker than the placebo and it tended to foam on drawing it up. Regardless during a cardiac arrest after we opened up an envelope we used whatever the directions said lidocaine or amiodarone. I have had two viable survivers back from lidocaine, no survivors back from what I thought was amiodarone during the trial. ACLS courses in our area are suggesting that amiodarone has better antiarrhymiant qualities verses the lidocaine, and eventually we might see a switch in amiodarone going to a more effective ACLS class of antiarrhythmiant over lidocaine.

I agree with this and from what I have heard and read, Amio is better as an antidysrhythmic for perfusing rhythms, especially VT compared to Lido. On the other hand, has Lidocaine itself ever been proven to be clinically effective or is it also of a VooDoo class of it's own (something that withstands the hands of time)?

[Dustdevil]

The big problem is that we have been jerked off for so long by the AHA that we really don't know what to believe anymore. Bretylium, anybody? :?

[nsmedic393]

Whatever be the case, our Provincial Medical Director has decided that we will be tossing the lidocaine and picking up amiodarone sometime in the next six months. Our protocols are evidence based so I'm guessing there was a good study done somewheres.

[turbosinaboy]

MM, nop. We don't hve procainamide.

I have heard it is VERY expensive and really hard to get here.

Now the new 2005 AHA & ECC guidelines are out in the wild for everyone. Procainamide is not anymore there.

Amiodarone is still before Lidocaine.

Until now we have no evidence to support the use of Lidocaine prior to Amiodarone. Basically because we are not making (at my EMS) any important/big data collection (good reason, huh?).

But even given the last results, something deeper in me still wonders what will happen when the Amiodarone's patent expires.

[Ridryder 911]

Actually, Pronestyl is still considered. Although, it is not mentioned it & other medications has not changed.( except Isuprel which has been totally removed) Yes, they are still trying to push Cordurone ( which is very expensive) and they cannot show any difference in outcome measures.

For more info on all the recent changes BLS and ACLS here is the AHA newsletter with comparisons of old & new...

http://www.americanheart.org/downloadable/...2Winter2005.pdf

[1EMT-P]

I have not used it in the field, but I have used most of the other medications. I urge you to check out the Richmond Ambulance Authority in Richmond, VA they were one of the first services to use it in the field & their Medical Director is considered to be an expert on it's use in the pre-hospital setting.

[RichmondMedik]

I have not used it in the field, but I have used most of the other medications. I urge you to check out the Richmond Ambulance Authority in Richmond, VA they were one of the first services to use it in the field & their Medical Director is considered to be an expert on it's use in the pre-hospital setting.

Yes We us it !!!!!!!!! J.P Ornato is our Medical Director who pushes us to be aggressive and do what is right for our patients -- our protocol for cardiac arrest is different from anywhere else I have seen

VF/Vtach

Vaso 40u WITH 300mg Amio

5 minutes later Epi With Amio 150mg

5 minutes later Vaso 40u WITH Amio 150mg

of course that is just our drug regime .. We can keep going till we either call it, get ROSC or run out of Vaso and Amio - of course we can also push,if indicated,Narcan,Sodium,Calcium Etc...

when we have a workable arrest we put the AUTOPULSE on first ( defib pads at same time) and get it running for 60 to 90 sec ( takes approx 3 minutes to deploy), intubate ( with ETCO2) ,IV and by that time we are checking the rhythm (we don't shock first unless it is witnessed by us)shock,if appropriate, and then start the drug regime.

Dr.O. has explained to me plenty of times that there is no magic bullet for out of hospital SCA but they are all little pieces of a pie/puzzle that help one another to work better

any ??? PM me I will be more that glad to pass on what I can

Paul

[flight-lp]

"Vaso 40u WITH 300mg Amio

5 minutes later Epi With Amio 150mg

5 minutes later Vaso 40u WITH Amio 150mg "

Man, talk about an Alpha rush!!!!!!!!!!!

That seems to be slightly excessive in my mind, why on earth would you want so much pure alpha drugs on board? I could see ROSC, but I can only imagine what 80 units of ADH plus Epi would do to ones neuro status. Not to mention an additional dose of Amio which is not recommended or needed. Studies have shown there is not direct benefit from the use of Amio vs. Lidocaine. I also question the practice of billing a patient or patients family for a very expensive medicine that is given in excessive amounts, especially when the practitioners know that the additional doses are A. harmful or B. ineffective.............

[paramedicmike]

Paul,

you and I have talked about this before. How about sharing with those who didn't get to eavesdrop on the conversation who Dr. O is, where he can be seen for quick reference, resus rates and why Dr O promotes such an agressive treatment.

BTW, now that the autopulse study has been halted, can you talk about your experience with the device yet? Or is this still hush-hush?

-be safe.

[Airmedic999]

I have all but stopped using Lidocaine now and use Amiodarone for refractory VF/VT and narrow and wide complex symptomatic tacycardias. Seem to have somewhat better results mananging the symptomatic arrythmias with Amiodarone than with Lidocaine...