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Brief review
Antiarrhythmic drugs in resuscitation
  1. D A Chamberlain
  1. 25 Woodland Drive, Hove, East Sussex BN3 6DH, UK
  1. Dr Chamberlain.

https://doi.org/10.1136/hrt.80.4.408

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    Drugs play a prominent part in the management of cardiorespiratory arrest, although rigid clinical evidence to demonstrate their value is sparse. Their use depends principally on tradition, on an unproven expectation that antiarrhythmic effects are likely to be beneficial for potentially lethal arrhythmias as well as for less malignant conditions, and on extrapolation from animal experiments. Irrespective of the lack or presence of acceptable evidence, drug administration to counter cardiac arrest has one or more objectives:

    • prophylaxis in high risk patients

    • countering ventricular fibrillation (VF) either directly or as an adjunct to electrical defibrillation

    • eliciting an electrical or mechanical response for patients with asystole or electromechanical dissociation

    • preventing recurrent VF

    • supporting the circulation during basic life support

    • improving the haemodynamic state after coordinated rhythm has been restored.

     Antiarrhythmic drugs used for the first four of these indications are discussed here.

    Prophylaxis for high risk patients

    Simple logic led to the use of antiarrhythmic drugs as prophylaxis against VF in high risk patients, notably after myocardial infarction. Antiarrhythmic drugs can prevent ventricular arrhythmias: VF is a ventricular arrhythmia, thus it is a reasonable expectation that such drugs may prevent VF. Most experience has been gained with lignocaine (lidocaine) because of its favourable pharmacological profile. Lignocaine causes relatively little myocardial depression,1 has little effect on impulse propagation, does not greatly influence vasomotor tone, is usually excreted rapidly after a few bolus doses, and has little proarrhythmic action.

    Two important trials lent support to the efficacy of lignocaine for the prevention of VF.2 ,3 The first by Lie et alin 1974 was an in-hospital study2; 212 consecutive patients younger than 70 years were randomly allocated within six hours of acute myocardial infarction to receive either intravenous lignocaine by bolus and infusion or placebo (5% glucose). Nine patients in the placebo group developed …

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