A 75-year-old male with AMI was admitted to the intensive care unit (ICU). Initially hemodynamically and respiratory stable, the patient’s heart rhythm suddenly changed into what appears to be a supraventricular tachycardia with a heart rate of 180 beats/min. The resident asks for your help and suggests administering lidocaine for the patient’s arrhythmia. As you discuss the plan at the bedside, the patient suddenly becomes unresponsive and ventricular tachycardia (VT) is noted on the telemetry.
Which of the following statements is MOST correct regarding the next steps in the patient’s management?
A. Amiodarone use improves survival of in-hospital cardiac arrestCorrect Answer: B
There is no randomized controlled trial (RCT) suggesting that use of amiodarone or lidocaine improves survival of in-hospital cardiac arrest. A recent, large RCT evaluating amiodarone versus lidocaine versus placebo suggests that in the setting of out-of-hospital cardiac arrest, amiodarone and lidocaine are superior to placebo with regards to survival to hospital and there was no difference between the two drugs. Unfortunately, there was no difference in the rate of survival-to-hospital discharge or favorable neurologic outcomes across all three groups in out-of-hospital cardiac arrest caused by VF/pVT. A prior, smaller RCT suggested that amiodarone administration would increase survival to hospital admission when compared with lidocaine administration. Lidocaine may suppress VF/pVT, however, may adversely affect mortality rates after AMI. The ACC/AHA guidelines further state that in patients with suspected AMI, prophylactic administration of lidocaine or high-dose amiodarone for the prevention of VT is potentially harmful. Amiodarone, but not lidocaine, should be considered as possible second- or third-line therapy for supraventricular tachycardia. Lidocaine has no role in treatment of supraventricular tachycardia, according to the AHA/ACC guidelines.
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