Methods
Data Sources
The authors performed a search of the NHS Library Evidence tool and MEDLINE from inception through May 15, 2016. Full-text review was generally restricted to articles in English, French, Spanish, German, or Italian. The decision to obtain full articles in other languages was made after review of the abstract. The references of identified articles were also hand searched.
Study Selection
Articles eligible for primary analysis selection included randomized controlled trials of patients with out-of-hospital cardiac arrest who received amiodarone compared with either lidocaine or placebo. Survival to admission, survival to discharge, and favorable neurologic outcome (defined as a modified Rankin Scale score ≤3) were the endpoints of interest. A preplanned secondary analysis also included nonrandomized comparative studies and studies of patients with inhospital cardiac arrest.
Data Extraction and Synthesis
Four authors independently performed data abstraction and disagreements were resolved by discussion, but the methods of extraction were otherwise unclear. Quality of methodology was assessed with the Cochrane Collaboration tool and the Newcastle-Ottawa Scale for randomized controlled trials and observational studies, respectively. Statistical analysis was performed with the Mantel-Haenszel method, generating odds ratios. Heterogeneity was reported with the I 2 statistic. Meta-analysis was performed with a random-effects model unless I 2 was less than 25%, in which case a fixed-effects model was used.
Methods
Data Sources
The authors performed a search of the NHS Library Evidence tool and MEDLINE from inception through May 15, 2016. Full-text review was generally restricted to articles in English, French, Spanish, German, or Italian. The decision to obtain full articles in other languages was made after review of the abstract. The references of identified articles were also hand searched.
Study Selection
Articles eligible for primary analysis selection included randomized controlled trials of patients with out-of-hospital cardiac arrest who received amiodarone compared with either lidocaine or placebo. Survival to admission, survival to discharge, and favorable neurologic outcome (defined as a modified Rankin Scale score ≤3) were the endpoints of interest. A preplanned secondary analysis also included nonrandomized comparative studies and studies of patients with inhospital cardiac arrest.
Data Extraction and Synthesis
Four authors independently performed data abstraction and disagreements were resolved by discussion, but the methods of extraction were otherwise unclear. Quality of methodology was assessed with the Cochrane Collaboration tool and the Newcastle-Ottawa Scale for randomized controlled trials and observational studies, respectively. Statistical analysis was performed with the Mantel-Haenszel method, generating odds ratios. Heterogeneity was reported with the I 2 statistic. Meta-analysis was performed with a random-effects model unless I 2 was less than 25%, in which case a fixed-effects model was used.
Results
Three randomized controlled trials (n=3,677) and 4 observational studies (n=704) were included for meta-analysis out of 528 articles identified on the initial search. The results were driven by a single large (n=3,026) randomized controlled trial at low risk of bias. The 2 smaller randomized controlled trials had moderate risk of bias, and the observational studies were generally at low risk of bias. Both lidocaine and amiodarone resulted in increased odds of survival to admission but no difference in survival to discharge or favorable neurologic outcome compared with placebo. None of the endpoints were statistically different when amiodarone was compared with lidocaine. Secondary analyses including observational studies yielded similar results. The primary results are reported in Table 1 with 95% confidence intervals and heterogeneity statistics.
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