Bayesian analysis of amiodarone or lidocaine versus placebo for out-of-hospital cardiac arrest

Daniel J. Lane, Brian Grunau, Peter Kudenchuk, Paul Dorian, Henry E. Wang, Mohamud R. Daya, Joshua Lupton, Christian Vaillancourt, Masashi Okubo, Daniel Davis, Thomas Rea, Demetris Yannopoulos, Jim Christenson, Frank Scheuermeyer

Research output: Contribution to journalArticlepeer-review

Abstract

Objective Clinical trials for patients with shock-refractory out-of-hospital cardiac arrest (OHCA), including the Amiodarone, Lidocaine or Placebo (ALPS) trial, have been unable to demonstrate definitive benefit after treatment with antiarrhythmic drugs. A Bayesian approach, combining the available evidence, may yield additional insights. Methods We conducted a reanalysis of the ALPS trial comparing treatment with amiodarone or lidocaine with placebo in patients with OHCA following shock-refractory ventricular fibrillation or ventricular tachycardia (VF/VT). We used Bayesian regression to assess the probability of improved survival or improved neurological outcome on the 7-point modified Rankin Scale. We derived weak, moderate and strong priors from a previous clinical trial. Results The original ALPS trial randomised 3026 adult patients with OHCA to amiodarone (n=974, survival to hospital discharge 24.4%), lidocaine, (n=993, survival 23.7%) or placebo (n=1059, survival 21.0%). In our reanalysis the probability of improved survival from amiodarone ranged from 83% (strong prior) to 95% (weak prior) compared with placebo and from 78% (strong) to 90% (weak) for lidocaine - an estimated improvement in survival of 2.9% (IQR 1.4%-3.8%) for amiodarone and 1.7% (IQR 0.84%-3.2%) for lidocaine over placebo (moderate prior). The probability of improved neurological outcome from amiodarone ranged from 96% (weak) to 99% (strong) compared with placebo and from 88% (weak) to 96% (strong) for lidocaine. Conclusions In a Bayesian reanalysis of patients with shock-resistant VF/VT OHCA, treatment with amiodarone had high probabilities of improved survival and neurological outcome, while treatment with lidocaine had a more modest benefit.

Original languageEnglish (US)
Pages (from-to)1777-1783
Number of pages7
JournalHeart
Volume108
Issue number22
DOIs
StatePublished - Mar 2 2022

Keywords

  • arrhythmias, cardiac
  • cardiac arrest
  • epidemiology
  • tachycardia, ventricular
  • ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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