Washington University Emergency Medicine Journal Club – May 2025
Vignette
You are doing a ride along with EMS on your EMS rotation when your crew is called to the scene of a cardiac arrest. The patient is a 50-year woman with cardiac arrest witnessed by coworkers. Per bystanders the patient began complaining of chest pain before collapsing into a coworker’s arms. A witness started CPR but no AED was available at the scene. You arrive approximately 10 minutes after arrest to find that the patient remains pulseless. The initial rhythm on your monitor is ventricular fibrillation (VF). You take over CPR as the paramedics place pads on the patient and start an IV. You shock the patient (biphasic, 200 J) and continue CPR. After 2 minutes, the rhythm remains VF. At that time the paramedics administer 300 mg of IV amiodarone as you shock the patient a 2nd time and load them on the truck. You continue CPR, shock the patient a 3rd time, and administer a 2nd dose of amiodarone (150 mg). After arrival to the ED, the patient is found to be in asystole, and after an additional 10 minutes of resuscitative efforts the code is called due to futility.
During a debriefing with the ED team, somebody mentions a recent pair of articles from the Annals of Emergency Medicine Clinical Controversies series in which authors debate the efficacy of amiodarone and lidocaine for pulseless ventricular tachycardia (VT) and VF. After the debrief you decide to check out these articles, then look at the articles cited by the authors to see which treatment you think is truly superior.
PICO Question
Population
Intervention
Comparison
Outcome
Search Strategy
Article 1: Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002 Mar 21;346(12):884-90. doi: 10.1056/NEJMoa013029. Erratum in: N Engl J Med 2002 Sep 19;347(12):955. PMID: 11907287. (Answer Key Pending)
Article 2: Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G, Morrison LJ, Leroux B, Vaillancourt C, Wittwer L, Callaway CW, Christenson J, Egan D, Ornato JP, Weisfeldt ML, Stiell IG, Idris AH, Aufderheide TP, Dunford JV, Colella MR, Vilke GM, Brienza AM, Desvigne-Nickens P, Gray PC, Gray R, Seals N, Straight R, Dorian P; Resuscitation Outcomes Consortium Investigators. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2016 May 5;374(18):1711-22. doi: 10.1056/NEJMoa1514204. Epub 2016 Apr 4. PMID: 27043165. (Answer Key Pending)
Article 3: Wang Q, Lin Z, Chen H, Pan B. Comparison the efficacy of amiodarone and lidocaine for cardiac arrest: A network meta-analysis. Medicine (Baltimore). 2023 Apr 14;102(15):e33195. doi: 10.1097/MD.0000000000033195. PMID: 37058064; PMCID: PMC10101268. (Answer Key Pending)
Article 4: Ali MU, Fitzpatrick-Lewis D, Kenny M, Raina P, Atkins DL, Soar J, Nolan J, Ristagno G, Sherifali D. Effectiveness of antiarrhythmic drugs for shockable cardiac arrest: A systematic review. Resuscitation. 2018 Nov;132:63-72. doi: 10.1016/j.resuscitation.2018.08.025. Epub 2018 Sep 1. PMID: 30179691. (Answer Key Pending)
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