What is the dosing for Lidocaine (generic name: Lidocaine) in the treatment of pulseless Ventricular Tachycardia (Vtach) or Ventricular Fibrillation (Vfib)?

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Last updated: April 20, 2025 • View editorial policy

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From the Guidelines

For pulseless VTach/VFib, lidocaine should be administered at a dose of 1.0 to 1.5 mg/kg IV/IO for the first dose and 0.5 to 0.75 mg/kg IV/IO for a second dose if required. This recommendation is based on the 2018 American Heart Association focused update on advanced cardiovascular life support, which emphasizes the importance of weight-based dosing for patient safety 1. The use of lidocaine in this context is supported by its inclusion in the ACLS algorithm for treatment of shock-refractory VF/pVT, alongside amiodarone.

Key Considerations

  • The recommended dose of lidocaine is weight-based, with a focus on patient safety 1.
  • A second dose of lidocaine may be administered if required, at a dose of 0.5 to 0.75 mg/kg IV/IO.
  • Lidocaine is considered a viable option for the treatment of pulseless VTach/VFib, particularly when amiodarone is unavailable or contraindicated.
  • The use of magnesium is not recommended routinely during cardiac arrest management, but may be considered for torsades de pointes 1.

Clinical Context

In the management of pulseless VTach/VFib, the primary goal is to restore a perfusing rhythm as quickly as possible. Lidocaine, with its ability to block sodium channels and stabilize cardiac cell membranes, plays a crucial role in achieving this goal. By administering lidocaine at the recommended dose, clinicians can help reduce the risk of morbidity and mortality associated with these life-threatening arrhythmias. As always, careful consideration of the patient's individual characteristics, including weight and potential contraindications, is essential for optimal treatment outcomes.

From the Research

Lidocaine Dosing for Pulseless Vtach/Vfib

  • The optimal dosing of lidocaine for pulseless Vtach/Vfib is not explicitly stated in the provided studies, but the studies compare the effectiveness of lidocaine and amiodarone in treating ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) cardiac arrest 2, 3, 4, 5.
  • A study from 2006 compared the survival rates of patients with in-hospital cardiac arrest due to pulseless ventricular tachycardia/ventricular fibrillation treated with lidocaine, amiodarone, or a combination of both, and found no difference in proportion of patients alive 24 hours post-cardiac arrest 3.
  • Another study from 2020 found that an amiodarone-first strategy was associated with the termination of VF/pVT using fewer shocks, but there were no significant differences in sustained return of spontaneous circulation, survival for 24 hours, survival, or favorable neurological outcomes at hospital discharge 4.
  • A 2023 study found that lidocaine was associated with statistically significantly higher odds of return of spontaneous circulation, 24-hour survival, survival to hospital discharge, and favorable neurologic outcome compared to amiodarone 5.
  • A systematic review from 2017 found that the confidence in effect estimates is low, and it is too speculative to recommend one agent over the other, suggesting that amiodarone or lidocaine can be used in the setting of pulseless ventricular tachycardia/ventricular fibrillation in infants and children 6.

Comparison of Lidocaine and Amiodarone

  • The studies suggest that both lidocaine and amiodarone can be effective in treating VF/pVT cardiac arrest, but the choice of agent may depend on various factors such as availability, cost, and patient-specific factors 2, 3, 4, 5.
  • The dosing of lidocaine is not explicitly stated in the provided studies, but it is likely that the standard dosing regimen is used, which is typically an initial bolus of 1-1.5 mg/kg followed by repeated doses of 0.5-0.75 mg/kg as needed 3.

Limitations and Future Studies

  • The studies have several limitations, including small sample sizes, retrospective designs, and variability in treatment protocols 3, 4, 5.
  • Further studies are needed to determine the optimal dosing and treatment strategies for lidocaine and amiodarone in the treatment of VF/pVT cardiac arrest 2, 3, 4, 5.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

6
Research

Amiodarone Versus Lidocaine for Pediatric Cardiac Arrest Due to Ventricular Arrhythmias: A Systematic Review.

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2017

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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