From the Guidelines
Lidocaine in cardiac arrest is administered as an initial 1.0 to 1.5 mg/kg IV bolus over 1-2 minutes, with a repeat dose of 0.5 to 0.75 mg/kg IV push allowed after 5-10 minutes if needed, not exceeding a total dose of 3 mg/kg.
Administration and Dosage
- The initial dose of lidocaine is 1.0 to 1.5 mg/kg IV, which can be approximated to a 100mg bolus for a typical adult patient [ 1 ].
- The repeat dose is 0.5 to 0.75 mg/kg IV push, administered at 5- to 10-minute intervals [ 1 ].
- The maximum total dose should not exceed 3 mg/kg.
Preference Over Amiodarone
- Lidocaine is preferred over amiodarone in situations where amiodarone is contraindicated or unavailable [ 1 ].
- Additionally, lidocaine may be considered in patients with liver failure or hypotension, as it has fewer immediate side effects compared to amiodarone.
Dose Reduction
- The dose of lidocaine should be reduced in patients with hepatic impairment, heart failure, shock, or those over 70 years old [ 1 ].
- A 50% reduction in dose is recommended for these patients, with a maximum total dose of 200-300mg.
Monitoring and Side Effects
- Patients receiving lidocaine should be monitored for CNS toxicity (confusion, seizures) and cardiovascular side effects (hypotension, bradycardia), especially in those with reduced clearance [ 1 ].
- Lidocaine works by stabilizing cardiac cell membranes through sodium channel blockade, which suppresses ventricular arrhythmias, making it particularly useful for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia after defibrillation attempts.
From the Research
Administration Time and Repeat Protocol for Lidocaine in Cardiac Arrest
- The administration time for the initial 100mg bolus of lidocaine is not explicitly stated in the provided studies, but it is generally administered over 1-2 minutes 2, 3.
- If there is a return of spontaneous circulation, the infusion can be set up, but the specific details of the infusion protocol are not provided in the studies.
- The bolus can be repeated after 10-15 minutes if necessary, but again, the exact repeat protocol is not specified in the studies.
Preference of Lidocaine over Amiodarone in Cardiac Arrest
- Lidocaine may be preferred over amiodarone in certain situations, such as in patients with witnessed cardiac arrest or in those with a higher likelihood of return of spontaneous circulation 4, 5.
- Lidocaine has been shown to be associated with higher rates of return of spontaneous circulation, 24-hour survival, survival to hospital discharge, and favorable neurologic outcome compared to amiodarone in some studies 4.
Dose Reduction for Lidocaine
- The dose of lidocaine may need to be reduced in certain situations, such as in patients with impaired liver function or in those with a history of seizures 3.
- However, the specific guidelines for dose reduction are not provided in the studies, and the initial dose of 100mg is generally recommended for most patients.
Situations Where Lidocaine is Preferred
- Lidocaine may be preferred in situations where the cardiac arrest is caused by ventricular fibrillation or pulseless ventricular tachycardia, and the patient has a higher likelihood of return of spontaneous circulation 5, 6.
- Early administration of lidocaine, particularly prior to the second defibrillator shock, may be associated with an increased odds of survival outcomes in in-hospital cardiac arrest with shockable rhythms 6.