Antiarrhythmics and their usefulness


Should we be using prehospital antiarrhythmics anymore?

The ALPS study seems like very good evidence against stocking extra unnecessary prehospital medications such as amid and lidocaine. My agency still has both on formulary and we probably spend more money are replacing expired meds than we do on preventing recurrent v-fib.

What are other’s thoughts on the AHA recommendations for the 300 then 150 of amiodirone or use of lidocaine for refractory VF?


It is tough to say if one study should remove all amiodarone and lidocaine from the field but if your agency has two agents they should probably be simplified to one and if you don’t have either you shouldn’t add one now. However AHA guidelines still recommend for administration for refractory v-fib so I won’t stop using it yet but recognize limited benefit


I think it is important to understand that Amiodarone and lidocaine were not associated with harm but “There was, however, heterogeneity of treatment affect with respect to whether the arrest was witnessed or not; both drugs were associated with a significant increase in survival rate amongst patient’s whose arrest was bystander-witnessed.”

PS: as this discussion progresses I will be filling out the wiki page for this study,_Lidocaine,_or_Placebo_in_Out-of-Hospital_Cardiac_Arrest


It is probably more likely that those who degenerate into refractory V-fib have longer arrests with less bystander cpr and those who have a witness arrest with a short treatment time have a greater survival benefit. Please correct me if I am wrong but that is how I interpret the heterogeneity of treatment effect in the study


in complete agreement here that there is really no need to change but we should all recognize the limitations of the current therapies and hopefully the next set of guidelines will lower the recommendations even further.