- For resuscitation of cardiac arrest with ventricular fibrillation (VF)/pulseless ventricular tachycardia (pVT), lidocaine is an option for a first-line treatment.
- Pediatric advanced life support (PALS) recommendations remain unchanged.
Why this matters
- Improving survival after cardiac arrest remains a key public-health challenge.
- International Liaison Committee on Resuscitation second annual review of CPR literature.
- 2018 American Heart Association (AHA) update regarding advanced cardiovascular life support: specifically, antiarrhythmic medications for adult and pediatric cardiac arrest and during return of spontaneous circulation (ROSC).
- Adults with shock-refractory VF/pVT:
- Authors suggest amiodarone or lidocaine, especially in witnessed arrest (weak recommendation, low-quality evidence [WR/LQE]).
- They advise against routine magnesium (WR, very LQE).
- Not enough evidence to make recommendations concerning bretylium, nifekalant, or sotalol, nor about antiarrhythmic prophylaxis during ROSC.
- Consider magnesium for adults experiencing torsades de pointes (WR/LQE).
- Adults with ROSC immediately after cardiac arrest:
- Insufficient evidence to advise in favor of or against routine beta-blockade or lidocaine in first hour.
- Consider prophylactic lidocaine if treatment of recurrent VF/pVT would be difficult, such as during transport (WR).
- Infants and children with shock-refractory VF/pVT arrest:
- Authors suggest amiodarone or lidocaine (WR, very LQE based on 1 study; recommendation unchanged since 2015).