A retrospective ‘target trial emulation’ comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation
Main finding · Prehospital ROSC (after PSM)Result — go to the resultAOR for prehospital ROSC 1.29 CI 1.16–1.44Authors' conclusion
Our 'target trial emulation' suggested that lidocaine was associated with greater odds of prehospital ROSC in comparison to amiodarone when administered during resuscitation from shock refractory or recurrent VF/VT.
Study context
- Population
- Adult non-traumatic out-of-hospital cardiac arrest (OHCA) before EMS arrival with shockable rhythm (defibrillation-refractory or recurrent VF/VT), ESO Data Collaborative 2018–20231,707 EMS agencies
- Participants
- 23,263 participants
- Exposure
- Lidocaine vs amiodarone during resuscitation
- Lidocainen = 2,979
- Amiodaronen = 20,284reference
- Outcome
- Prehospital ROSC
Methodological detailstarget trial emulation, propensity-score matched, multicentre registry
- Target trial emulation
- Propensity-score matched
- Multicentre registry
Main finding
Prehospital ROSC (after PSM)
AOR for prehospital return of spontaneous circulation (ROSC)
1.29
CI 1.16–1.44
By group
Lidocaine
36.0
%
Amiodarone
30.4%
Lidocaine vs Amiodarone
aOR for prehospital ROSC 1.29 (CI 1.16–1.44)
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
Prehospital ROSC (before PSM)
Denominator Lidocaine 2,979 · Amiodarone 20,284
| Outcome | Lidocaine | Amiodarone | OR for survival to discharge (CI) | |
|---|---|---|---|---|
| Survival to hospital discharge (after PSM)n = 538 pairs | 35.1 % | 25.7% | 1.54 (1.19–2.00) | |
| 0.512OR for survival to discharge (log scale) |
| Outcome | Lidocaine | Amiodarone | P value |
|---|---|---|---|
| Number of post-drug defibrillations (after PSM) | median 2 (bracketed interval (type not stated) 0–4) | median 2 (bracketed interval (type not stated) 0–6) | P < 0.01 |
| Mean | 3.3 | 3.9 |
- Number of post-drug defibrillations (after propensity score matching (PSM)): n = 2,976 pairs; fewer post-drug defibrillations with lidocaine
Original publication
A retrospective ‘target trial emulation’ comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. Resuscitation. Published 23 January 2025. doi:10.
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