Friday, 30 June 2017

A meta-analysis of amiodarone or lidocaine for cardiac arrest: when crunching numbers is not appropriate

No anti-arrhythmic drugs have been proven to result in increased meaningful outcomes after cardiac arrest. Sure, a larger proportion of patients arrive at the hospital alive but they all die anyway.

A recent RCT of 3026 patients published in 2016 reported about a 3% trend towards improved survival to hospital discharge with amiodarone or lidocaine as compared to placebo. If this trend was true, it would be rather important. A NNT of 33 for survival is nothing to shake a stick at!

Perhaps a systematic review & meta-analysis with more statistical power give us the answer? Why not.

These well intended authors conducted such a study.

As is often the case, their search found tons of papers but in the end only 3 RCT’s.

One RCT had 3026 patients… sound familiar?

The other two only enrolled 347 and 304 patients respectively. To be clear, 80% of the data comes from one study.

So, the authors quit here and acknowledged they shouldn’t go much further until such time more evidence became available.

Just joking…

Of course they crunched some numbers and came to some conclusions. As expected, it didn’t really provide us with any new information.

To be fair, their overall methods were good as was the discussion. I thought their advocacy for the reconsideration of lidocaine was interesting and probably correct. It’s great when things come full circle.

In the end, the jury is still out. But we knew this already… with no need for crunching.


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