-
Amiodarone has replaced Lidocaine as first line agent in ACLS and PALS protocols
- However Lidocaine may have higher rate of ROSC and lower morbidity and mortality than Amiodarone
- Wagner (2023) Chest 163(5):1109-1119 +PMID: 36332663 [PubMed]
- Ventricular Fibrillation
-
Ventricular Tachycardia (Wide Complex Tachycardia)
- Use Lidocaine only if unknown etiology
- Not indicated for drug induced Arrhythmia
- Not indicated for metabolic induced Arrhythmia
- Post-Resuscitation for ventricular Arrhythmia
- Myocarditis
- Structural heart disease
- Wide-complex Ventricular Escape Rhythm
- Associated with Bradycardia
- See Lidocaine Local Skin Anesthesia
- Class Ib Antiarrhythmic Drug
- Increases conduction velocity in the AV Node, His Bundle and Purkinje Fibers
- Shortens QT Interval
- Suppresses ventricular Arrhythmias
- Terminates reentrant ventricular Arrhythmia
- Increases Ventricular Fibrillation threshold
- Requires high plasma Lidocaine levels (e.g. 6 mcg/ml)
- Suppresses ventricular ectopy (decreases automaticity)
- Post Myocardial Infarction, routine prophylactic Lidocaine use not recommended
- Pediatric
- Dose: 1 mg/kg IV/IO every 10 to 15 min up to 3 to 5 mg/kg in 1 hour
- ET Dose: Use 2 to 2.5 times the IV dose
- May continue with infusion dosing as below
- Adult
-
Ventricular Fibrillation
- Dose: 1.0-1.5 mg/kg IV/IO push
- ET Dose: Use 2 to 2.5 times the IV dose in 10 ml Normal Saline
- May repeat in 3-5 min to max dose 3 mg/kg
- May continue with infusion dosing as below
-
Ventricular Tachycardia (with a pulse)
- First: 1.0-1.5 mg/kg IV/IO push
- Next: 0.5-0.75 mg/kg IV/IO push every 5 to 10 minutes
- Maximum total, cumulative dose: 3 mg/kg
- May continue with infusion dosing as below
- Infusion (Pediatric and Adult)
- Preparation
- Lidocaine 4 g in 500 ml D5W (8 mg/ml)
- Precede infusion with 1 mg/kg bolus loading dose
- Then 20-50 mcg/kg/min up to 1 to 4 mg/min infusion
- If hepatic Blood Flow is compromised (e.g. CHF, liver disease, elderly)
- Decrease dose to under 20 mcg/kg/min
- Myocardial depression of conduction and contractility
- Concurrent Antiarrhythmic therapy
- Sick Sinus Syndrome
- Left Ventricular Dysfunction
- Circulatory depression
- May occur with rapid bolus dosing
- Neurologic changes (esp. with prolonged infusion)
- Drowsiness or Disorientation
- Decreased Hearing acuity
- Paresthesias
- Muscle Twitching (Fasciculations)
- Seizures (high dose)
- Overdosage
- Third degree AV Heart Block
- Altered AV conduction
- Sinus node automaticity depressed
- Unknown safety in Lactation
- Pregnancy Category B
- Rapid hepatic metabolism (to 2 active metabolites)
- Renal excretion
- Lidocaine serum levels increased by other medications
- Cimetidine
- Medications that reduce hepatic perfusion (e.g. Beta Blockers)
- Lidocaine Injection Solution (DailyMed)
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 74-5
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Panchal (2018) Circulation 138(23):e740-e749 +PMID: 30571262 [PubMed]