Long-term Efficacy Of Amiodarone And/or Lidocaine For Cardiac Arrest:A Bayesian Network Meta-analysis

Objective:Available studies have not demonstrated that antiarrhythmic drugs could increase long-term survival or survival with favorable neurological outcome in patients with cardiac arrest,but some studies have shown that rates of hospital admission and return of spontaneous circulation(ROSC)are higher with amiodarone or lidocaine than with placebo.However,we are more concerned with long-term survival and future quality of life than these short-term outcomes.To investigate the long-term prognostic effects of antiarrhythmic drugs in patients with cardiac arrest,we conduct a meta-analysis to evaluate the efficacy of amiodarone and/or lidocaine.Methods:We included studies published in PubMed,The Cochrane Library,Web Of Science,EMBASE,VIP,Wanfang,CBM and CNKI databases from inception until Jan 21 th,2020,and manually searched The gray literature,trial registration platform and The websites Of drug approval agencies to supplement The electronic database.By using stata software and Win BUGS software,we conduct a Bayesian network meta-analysis.The main endpoint was survival to hospital discharge in cardiac arrest,and the minor endpoint was favorable neurological outcome.Results:A total of 9,041 studies were included in the preliminary screening,and 8 studies were included,involving 3 randomized clinical trials(RCT)and 5 observational studies.In terms of survival to hospital discharge,the surface under cumulative ranking curve(SUCRA)ranked lidocaine first(SUCRA 84.64%),amiodarone second(SUCRA61.64%),placebo third(SUCRA 48.19%),and amiodarone combined with lidocaine fourth(SUCRA 5.53%).However,there were no significant difference that lidocaine compared to amiodarone(odds ratio [OR] 1.08,95% credible interval [95% CI]0.92-1.26),amiodarone combined with lidocaine(OR 2.38,95% CI 0.97-5.80)and placebo(OR 1.17,95% CI 0.94-1.46)in head-to-head studies.Because there is currently no literature on amiodarone combined with lidocaine in terms of favorable neurological outcomes,SUCRA only performed a ranking of the remaining three therapeutic interventions.Amiodarone ranked first(SUCRA 76.66%),lidocaine ranked second(SUCRA 46.70%),placebo ranked third(SUCRA 26.64%).However,there were no significant difference that amiodarone compared to lidocaine(OR 1.08,95% CI0.87-1.36)and placebo(OR 1.15,95% CI 0.93-1.43)in head-to-head studies.Conclusion:Lidocaine had the best effect on survival to hospital discharge,while amiodarone was associated with a more favorable neurological outcome.Trial registration: This study is registered with PROSPERO,number CRD42020171049.