Cardiovascular Drugs and Therapy

, Volume 30, Issue 5, pp 485–491 | Cite as

Amiodarone Compared with Lidocaine for Out-Of-Hospital Cardiac Arrest with Refractory Ventricular Fibrillation on Hospital Arrival: a Nationwide Database Study

  • Takashi Tagami
  • Hiroki Matsui
  • Chie Tanaka
  • Junya Kaneko
  • Masamune Kuno
  • Saori Ishinokami
  • Kyoko Unemoto
  • Kiyohide Fushimi
  • Hideo Yasunaga



The latest resuscitation guidelines recommend the use of amiodarone in adult patients with out-of-hospital cardiac arrest (OHCA) and refractory ventricular fibrillation (VF) to improve the rates of return of spontaneous circulation. However, there is limited evidence to suggest that amiodarone is superior to lidocaine with respect to survival at discharge. The purpose of the present study was to evaluate the hypothesis that amiodarone is superior to lidocaine with regard to the rate of survival to hospital discharge for OHCA patients with VF/pulseless VT (pVT) on hospital arrival.


Using the Japanese Diagnosis Procedure Combination inpatient database, we identified 3951 patients from 795 hospitals who experienced cardiogenic OHCA and had refractory ventricular fibrillation on hospital arrival between July 2007 and March 2013. The patients were categorized into amiodarone (n = 1743) and lidocaine (n = 2208) groups, from which 801 propensity score-matched pairs were generated.


There was no significant difference in the rate of survival to hospital discharge between the amiodarone and lidocaine groups (15.2 % vs. 17.1 %; difference, −1.9 %; 95 % CI, −5.5 to 1.7) in propensity score-matched analyses. Cox regression analyses did not indicate significant in-hospital mortality differences between the amiodarone and lidocaine groups for the propensity score-matched groups (hazard ratio, 1.05; 95 % CI, 0.94 to 1.17).


The present nationwide study suggested that there was no significant difference in the rate of survival to hospital discharge between cardiogenic OHCA patients with persistent ventricular fibrillation on hospital arrival treated with amiodarone or lidocaine.


Amiodarone Antiarrhythmic Cardiac arrhythmias CPR 



This work was supported by Grants for Research on Policy Planning and Evaluation from the Ministry of Health, Labour and Welfare, Japan (Grant Numbers: H27-Policy-Designated-009 to Prof. Fushimi and Prof. Yasunaga; H27-Policy-Strategy-011 to Prof. Yasunaga) and a Grant-in-Aid for Scientific Research, Japan (Grant Number: KAKENHI-15H05685 to Dr. Tagami). The funders had no role in the execution of this study or the interpretation of the results.


  1. 1.
    Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation. 2005;67:75–80.CrossRefPubMedGoogle Scholar
  2. 2.
    Kitamura T, Iwami T, Kawamura T, et al. Nationwide improvements in survival from out-of-hospital cardiac arrest in Japan. Circulation. 2012;126:2834–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Nichol G, Thomas E, Callaway CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008;300:1423–31.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Callaway CW, Soar J, Aibiki M, et al. Part 4: advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132:S84–S145.CrossRefPubMedGoogle Scholar
  5. 5.
    Soar J, Nolan JP, Bottiger BW, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation. 2015;95:100–47.CrossRefPubMedGoogle Scholar
  6. 6.
    Dorian P, Cass D, Schwartz B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002;346:884–90.CrossRefPubMedGoogle Scholar
  7. 7.
    Kudenchuk PJ, Brown SP, Daya M, et al. Amiodarone, lidocaine, or placebo in out-of-hospital cardiac arrest. N Engl J Med. 2016;374:1711–22.CrossRefPubMedGoogle Scholar
  8. 8.
    Tagami T, Hirata K, Takeshige T, et al. Implementation of the fifth link of the chain of survival concept for out-of-hospital cardiac arrest. Circulation. 2012;126:589–97.CrossRefPubMedGoogle Scholar
  9. 9.
    Tagami T, Matsui H, Fushimi K, Yasunaga H. Prophylactic antibiotics may improve outcome in patients with severe burns requiring mechanical ventilation: propensity score analysis of a Japanese Nationwide database. Clin Infect Dis. 2016;62:60–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Tagami T, Matsui H, Fushimi K, Yasunaga H. Changes in therapeutic hypothermia and coronary intervention provision and In-hospital mortality of patients with out-of-hospital cardiac arrest: a Nationwide database study. Crit Care Med. 2016;44:488–95.CrossRefPubMedGoogle Scholar
  11. 11.
    Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H. Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients. Eur Respir J. 2015;45:463–72.CrossRefPubMedGoogle Scholar
  12. 12.
    Jacobs I, Nadkarni V, Bahr J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European resuscitation council, Australian resuscitation council, New Zealand resuscitation council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, resuscitation councils of southern Africa. Circulation. 2004;110:3385–97.CrossRefPubMedGoogle Scholar
  13. 13.
    Perkins GD, Jacobs IG, Nadkarni VM, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the international liaison committee on resuscitation (american heart association, european resuscitation council, australian and new zealand council on resuscitation, heart and stroke foundation of canada, interamerican heart foundation, resuscitation council of southern africa, resuscitation council of asia); and the american heart association emergency cardiovascular care committee and the council on cardiopulmonary, critical care, perioperative and resuscitation. Circulation. 2015;132:1286–300.CrossRefPubMedGoogle Scholar
  14. 14.
    Austin PC. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med. 2014;33:1242–58.CrossRefPubMedGoogle Scholar
  15. 15.
    Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Part 6: advanced cardiovascular life support: section 5: pharmacology i: agents for arrhythmias. The american heart association in collaboration with the international liaison committee on resuscitation. Circulation. 2000; 102:I112–28.Google Scholar
  16. 16.
    Herlitz J, Ekstrom L, Wennerblom B, et al. Lidocaine in out-of-hospital ventricular fibrillation. Does it improve survival? Resuscitation. 1997;33:199–205.CrossRefPubMedGoogle Scholar
  17. 17.
    Harrison EE. Lidocaine in prehospital countershock refractory ventricular fibrillation. Ann Emerg Med. 1981;10:420–3.CrossRefPubMedGoogle Scholar
  18. 18.
    Weaver WD, Fahrenbruch CE, Johnson DD, et al. Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation. Circulation. 1990;82:2027–34.CrossRefPubMedGoogle Scholar
  19. 19.
    Kudenchuk PJ, Cobb LA, Copass MK, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med. 1999;341:871–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Salgado HC, Simoes GM, Santana Filho VJ, et al. Negative inotropic and lusitropic effects of intravenous amiodarone in conscious rats. Clin Exp Pharmacol Physiol. 2007;34:870–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Cushing DJ, Cooper WD, Gralinski MR, Lipicky RJ. The hypotensive effect of intravenous amiodarone is sustained throughout the maintenance infusion period. Clin Exp Pharmacol Physiol. 2010;37:358–61.CrossRefPubMedGoogle Scholar
  22. 22.
    Doshi D, Jayawardana R. Amiodarone-induced life-threatening refractory hypotension. Am J Case Rep. 2015;16:617–20.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Takashi Tagami
    • 1
    • 2
  • Hiroki Matsui
    • 1
  • Chie Tanaka
    • 2
  • Junya Kaneko
    • 2
  • Masamune Kuno
    • 2
  • Saori Ishinokami
    • 2
  • Kyoko Unemoto
    • 2
  • Kiyohide Fushimi
    • 3
  • Hideo Yasunaga
    • 1
  1. 1.Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTokyoJapan
  3. 3.Department of Health Informatics and Policy, Graduate School of MedicineTokyo Medical and Dental UniversityTokyoJapan

Personalised recommendations