Amiodarone after Lidocaine?

Question

With all the controversy about Amiodarone vs Lidocaine its hard to find accurate info out there. Can you give Amiodarone after Lidocaine or visa versa?

Answer 1

I've heard that only one antiarrhythmic med per code is preferred; due to the possibility of adverse reactions when you combine two or more antiarrhythmics (can actually cause arrhythmia).

However, it's up to your med control doc to decide that. At my service, we only carried Lidocaine until recently. Now we carry Amiodarone, too. If I ever get into that situation, I'll just call med control to get permission to give a second round of antiarrhythmics.

I checked with my fiancee (also a medic) and he said that he was taught not to give two antiarrhythmics. Just stick with one, and if it doesn't work, then just continue with epi, CPR, and such.

Another friend (also a paramedic, but not quite as bright) says it's OK to give two antiarrhythmics in a code.

In conclusion, I'd just give one (either Lidocaine or Amiodarone) and stick with that until told otherwise.

Hope this helps...

P.S. Check out my question...do you know any funny acronyms for AMR?

Answer 2

Although lidocaine is the drug traditionally used to treat ventricular fibrillation (VF) after out-of-hospital cardiac arrest, there is little evidence demonstrating its efficacy in this situation. A new study has shown that intravenous amiodarone is superior to lidocaine as an adjunct to defibrillation for patients who arrested outside the hospital with “shock-resistant” VF (ie, VF that persists after three unsuccessful defibrillation attempts).

Results of the study, known as the Amiodarone Versus Lidocaine in Prehospital Ventricular Fibrillation Evaluation (ALIVE) trial, demonstrated that 23% of the patients given amiodarone by paramedics for shock-resistant VF survived to hospital admission, compared with 12% of those treated with lidocaine. “That difference was not just statistically significant but also clinically meaningful,” lead investigator Paul Dorian, MD, told PULMONARY REVIEWS.

Answer 3

Take your pick. Death is a really poor prognostic sign, and no drug really makes that much difference in outcome, though amiodarone seems to let the patient die in the expensive care unit instead of the field or the emergency department better. How much of a clinical improvement this is is up for debate.

Answer 4

Amiodarone Vs Lidocaine

Answer 5

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