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Lidocaine may be considered a suitable antiarrhythmic that can be used to treat cardiac arrest from VT/VF.
Lidocaine is now included in the AHA Cardiac Arrest diagram along with amdidoarne. Emphasis should not be on the use of medications and it is the AHA recommendation to place more emphasis on high quality CPR and early defibrillation.
Lidocaine indications for ACLS
- In ACLS, Lidocaine is used intravenously for the treatment of ventricular arrhythmias. (VT/VF)
- It is also useful for the treatment of stable monomorphic VT with preserved ventricular function and for stable polymorphic VT with preserved left ventricular function, normal QT interval, and correction of any electrolyte imbalances.
The overall benefits of lidocaine for the treatment arrhythmias in cardiac arrest has come under scrutiny. It has been shown to have no short term or long term efficacy in cardiac arrest.
Routine prophylactic use is contraindicated for acute myocardial infarction.
Side Effects
Lidocaine should be used with caution due to negative cardiovascular effects which include hypotension, bradycardia, arrhythmias, and/or cardiac arrest. Some of these side effects may be due to hypoxemia secondary to respiratory depression.
Lidocaine Toxicity
Symptoms of lidocaine toxicity progress in the following predictable pattern. It begins with numbness of the tongue, lightheadedness, and visual disturbances and progresses to muscle twitching, unconsciousness, and seizures, then coma, respiratory arrest, and cardiovascular depression.
There are several conditions that increase the potential for lidocaine toxicity:
- Liver dysfunction increases the risk of toxicity due to lidocaine being metabolized by the liver.
- Low protein increases the risk of toxicity because lidocaine is protein bound.
- Acidosis can also increase the risk of toxicity since acidosis increase the potential of lidocaine to dissociate from plasma proteins.
Dosing
Cardiac Arrest from VT/VF:
- Initial dose: 1 to 1.5 mg/kg IV/IO
- For refractory VF may give additional 0.5 to 0.75 mg/kg IV push, repeat in 5 to 10 minutes; maximum 3 doses or total of 3mg/kg
Perfusing Arrhythmia:
For stable VT, wide-complex tachycardia of uncertain type and significant ectopy:
- Doses Range from 0.5 to 0.75 mg/kg and up to 1 to 1.5mg/kg
- Repeat 0.5 to 0.75 mg/kg every 5-10 minutes with maximum total dose of 3 mg/kg
Maintenance infusion:
- 1 to 4 mg/min (30-50 mcg/kg/min)
Discontinue a lidocaine infusion immediately if signs of toxicity develop.
jeannetta says
can lidocaine infusion and amiodarone infusion given at same time to a patient with satble VT
Jeff with admin. says
Amiodarone and lidocaine can be given concurrently. Kind regards, Jeff
sampsonanya says
Please I’m a little bit confused about the drugs given through ET T, what’s the generic name for narcan?
Jeff with admin. says
The generic name for narcan is “naloxone.”
Kind regards,
Jeff
saira says
can lidocaine be used for hemodynamically stable non-sustained VT in the setting of normal electrolytes, left ventricular function and decompenseated liver disease?
Jeff with admin. says
I do not know why you would want to use lidocaine if the patient is hemodynamically stable and the VT is non-sustained. AHA ACLS protocol would call for expert consultation at this point. Lidocaine is not listed as a treatment of choice for stable non-sustained VT with a pulse. Amiodarone is. I personally would get the expert advice of a cardiologist especially since the patient is stable.
Kind regards,
Jeff
Gayl says
Can Amiodarone be pushed IVP, without being diluted in D5W, for a patient in V Tach with a pulse. Had a doctor yelling at us to do this, but I reminded him that Amiodarone for perfusing V Tach (stable) needed to be dripped over 10 minutes.
Jeff with admin. says
Amiodarone can be pushed. It is better to dilute the amiodarone in 10 to 20 ml of D5W, but it can be given undiluted.
In the case of stable VT, it is appropriate to infuse the amiodarone over 10 minutes. Rapid IV push of amiodarone should be reserved for unstable VT, pulseless VT and VF.
Kind regards,
Jeff
Lisa says
So amiodarone with D5W…Nor Epi as well right?? Others with NS
All ACLS drugs can be pushed as fast as you can during a code..however please tell me more on the drips..trying to make it simple
If I were to start a drip of amiodarone…in the ER what to should I know…also Lidocaine and Epi
Also what about filters
Jeff with admin. says
Norepinephrine is usually diluted with D5W. Other fluids are diluted with NS. All ACLS drugs during a code are pushed as fast as possible and followed with 20ml of NS. Drips in the post arrest phase are hung just as any other drips are. Amiodarone does need a filter. None of the others do.
All drips should be titrated up or down for affect.
Kind regards,
Jeff
Emily says
I know we use Lidocaine as a laryngojet to help with coughing against ett. Does putting lidocaine down the ETT help also with ectopy or other ventricular arrythmias, kind of like how we can put epi down the ett for administration? We were having a conversatoin about this at work tonight and I was just wondering 🙂
Jeff with admin. says
Lidocaine can be administered via endotracheal tube, dilute dose in 5–10 mL of 0.9% sodium chloride or sterile water or flush with a minimum of 5 mL of 0.9% sodium chloride followed by manual ventilations .
Kind regards,
Jeff
JASNA says
WHAT IS THE REASON FR AMIODARONE INFUTOIN IN D5W?
Jeff with admin. says
The medication can possibly precipitate and form solid crystals in any other solution.
Kind regards,
Jeff
JASNA says
if 100mg lidocane should be diluted?if yes in how much ml NS?
Jeff with admin. says
Suggested concentration: 2 Gms/500 .9 N/S
Please try and keep the questions to things that are not so easily looked up in a drug guide book.
Kind regards,
Jeff
JASNA says
Can megnisium infused in NS?
Jeff with admin. says
Yes, magnesium can be infused with NS.
In an emergency situation it would be pushed.
Kind regards,
Jeff
JASNA says
which is the fluid used for lidocaine infusion?
Jeff with admin. says
Lidocaine can be diluted with NS also.
About the only listed in the ACLS core medications that cannot be diluted with NS is amiodarone.
Dilute an amiodarone infusion with D5W.
Kind regards,
Jeff
h NS also.
About the only listed in the ACLS core medications that cannot be diluted with NS is amiodarone.
Dilute an amiodarone infusion with D5W.
Kind regards,
Jeff
JASNA says
WHAT IS REFRACTORY VF?
Jeff with admin. says
Refractory VF is ventricular fibrillation that will not respond to standard treatments for VF. To put it another way, it is VF that won’t go away when shocked or treated with medications.
Kind regards,
Jeff
Mark Rogers says
Is Epinephrine as a stand alone chatecholemine adequte per ACLS guidelines?
Jeff with admin. says
Epinephrine is the only catecholamine used in the AHA pulseless arrest algorithm so I suppose that you could say it stands alone.
Vasopressin, Amiodarone, and Lidocaine which are also mentioned in the guidelines for the pulseless arrest algorithm are not catecholamines.
Dopamine and Norepineprine which are catecholamines that are used in the post arrest phase of ACLS protocol.
Kind regards,
Jeff
Matthew says
Hey, just wanted to know when they brought Amiodarone on-board in the ACLS algorithms? Just a year would suffice.
Thanks
Jeff with admin. says
This AHA article from 1999 summarizes the AHA position at that time. I would say around 1999 was when AHA was seriously looking at amiodarone for its antiarrhythmic properties. Studies have been going on since at least 1985.
Kind regards,
Jeff
sifamon says
What is perfusing arrhythmia?…Thank you
Jeff with admin. says
A perfusing arrhythmia is an abnormal heart rhythm that continues to produce effective cardiac output.
Kind regards,
Jeff
Shirna says
What are the drugs used for the ETT route other than narcan, vasopressin, and epinephrine per your information?
I learned L-A-N-E (lidocaine, atropine, narcan, and epinephrine).
Jeff with admin. says
Correct but also vasopressin.
Here is another way:
NAVEL
N arcan (must be diluted)
A tropine
E pinephrine
V asopressin
L idocaine
Louise says
I am confused. LEAN was the last acronym I was taught for ETT drugs. Lidocaine, epi, atropine, narcan. Is NAVEL still appropriate and useful?
Thank you for your site, it is being a great help.
Jeff with admin. says
Either on will work, but you need to had a V to the LEAN. Vasopressin can be given by ET tube as well. NAVEL uses all of the letters with a word that is easy to remember.
Kind regards,
Jeff