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Ali MU, Fitzpatrick-Lewis D, Kenny M, et al. Effectiveness of antiarrhythmic drugs for shockable cardiac arrest: A systematic review. Resuscitation. 2018 Sep 1;132:63-72. doi: 10.1016/j.resuscitation.2018.08.025.
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Hospital Doctor/Hospitalists
Internal Medicine
Pediatric Emergency Medicine
Emergency Medicine
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PURPOSE: The purpose of this systematic review is to provide up-to-date evidence on effectiveness of antiarrhythmic drugs for shockable cardiac arrest to help inform the 2018 International Liaison Committee on Resuscitation Consensus on Science with Treatment Recommendations.

METHODS: A search was conducted in electronic databases Medline, Embase, and Cochrane Library from inception to August 15, 2017.

RESULTS: Of the 9371 citations reviewed, a total of 14 RCTs and 17 observational studies met our inclusion criteria for adult population and only 1 observational study for pediatric population. Based on RCT level evidence for adult population, none of the anti-arrhythmic drugs showed any difference in effect compared with placebo, or with other anti-arrhythmic drugs for the critical outcomes of survival to hospital discharge and discharge with good neurological function. For the outcome of return of spontaneous circulation, the results showed a significant increase for lidocaine compared with placebo (RR = 1.16; 95% CI, 1.03-1.29, p = 0.01).

CONCLUSION: The high level evidence supporting the use of antiarrhythmic drugs during CPR for shockable cardiac arrest is limited and showed no benefit for critical outcomes of survival at hospital discharge, survival with favorable neurological function and long-term survival. Future high quality research is needed to confirm these findings and also to evaluate the role of administering antiarrhythmic drugs in children with shockable cardiac arrest, and in adults immediately after ROSC.

Comments from MORE raters

Cardiology rater

Interesting review but further studies are needed.

Emergency Medicine rater

This does not appear to be a methodologically robust SR and is not PRISMA compliant.

Emergency Medicine rater

This review adds to an already substantial literature that demonstrates that drugs for cardiac arrest do not increase the rate of clinically valuable outcomes even though they may lead to fruitless ICU admissions.

Emergency Medicine rater

The time from collapse to medication in many of these studies is > 20 minutes. Based on this, one cannot conclude that the medications are ineffective, only that they are ineffective if delivered in the latter phases of resuscitation.

Hospital Doctor/Hospitalists rater

Certainly interesting. For most hospitalists, the approach to cardiac arrest is very anchored in the ACLS protocols as well as local practice. Amiodarone and lidocaine are in the most current protocol for shockable cardiac arrest from 2015.

Internal Medicine rater

Excellent systematic review and meta-analysis. Unfortunately, most of the RCTs were under-powered to make an absolute recommendation to abandon all anti-arrhythmics for shockable cardiac arrests.

Pediatric Emergency Medicine rater

Useful negative study showing lack of effectiveness of anti-arrhythmic drugs in shockable cardiac arrest.