Amiodarone, lidocaine, magnesium or placebo in shock refractory ventricular arrhythmia: A Bayesian network meta-analysis

Recent evidence challenges, the superiority of amiodarone, compared to other anti-arrhythmic medications, as the agent of choice in pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF). We conducted Bayesian network and traditional meta-analyses to investigate the relative efficacies of amiodarone, lidocaine, magnesium (MgSO4) and placebo as treatments for pulseless VT or VF. Eleven studies [5200 patients, 7 randomized trials (4, 611 patients) and 4 non-randomized studies (589 patients)], were included in this meta-analysis. The search was conducted, from 1981 to February 2017, using MEDLINE, EMBASE and The Cochrane Library. Estimates were reported as odds ratio (OR) with 95% Credible Interval (CrI). Markov chain Monte Carlo (MCMC) modeling was used to estimate the relative ranking probability of each treatment group based on surface under cumulative ranking curve (SUCRA). Bayesian analysis demonstrated that lidocaine had superior effects on survival to hospital discharge, compared to amiodarone (OR, 2.18, 95% Cr.I 1.26-3.13), MgSO4 (OR, 2.03, 95% Cr.I 0.74-4.82) and placebo (OR, 2.42, 95% Cr.I 1.39-3.54). There were no statistical differences among treatment groups regarding survival to hospital admission/24 h (hrs) and return of spontaneous circulation (ROSC). Probability analysis revealed that lidocaine was the most effective therapy for survival to hospital discharge (SUCRA, 97%). We conclude that lidocaine may be the most effective anti-arrhythmic agent for survival to hospital discharge in patients with pulseless VT or VF.