Chest pain: no clear benefit from prophylactic lidocaine

Clinical bottom line (level 1b-)

  1. Patients who develop chest pain out of hospital who receive lidocaine are not clearly less likely to develop warning arrhythmias or die than those who do not.
Hargarten et al: Annals of Emergency Medicine 1986; 15 (8): 881-885
Expires November 2001

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: county, USA

446 patients (aged mean 65, ?% male) with cardiac chest pain

Excluded if
  • systolic blood pressure < 90 mmHg
  • bradyarrhythmias < 50 beats/minute
  • second or third degree heart blocks, or evidence of 'warning arrhythmias' on ECG (6 PVCs per minute, multiform PVCs, R-on-Tphenomenon, couplets and runs of ventricular extrasystoles)


    • Control Group: (n = 224, 224 analysed): no therapy
    Experimental Group: (n = 222, 222 analysed): lidocaine 1mg /kg iv bolus and a simultaneous 2mg /min drip.Patients with congestive heart failure or a history of liver failure received halfthe dose.

    100% followed for ? length of hospital stay

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    premature ventriuclar contractions or heart rate < 50 unknown 8
    (3.57%)    		 3
    (1.35%)    		 62%
    (-41% to 90%)    		 2.22%
    (-0.65% to 5.09%)    		 45
    (NNT = 50 to infinity;
    NNH = 155 to infinity)
    death unknown 15
    (6.70%)    		 18
    (8.11%)    		 -21%
    (-134% to 37%)    		 -1.41%
    (-6.27% to 3.45%)    		 -71
    (NNT = 29 to infinity;
    NNH = 16 to infinity)

    Comments

    1. The study is too small to exclude potential benefit or harm from using lidocaine.
    2. Further studies and meta-analysis suggest routine use of lidocainemay be harmful (e.g. myocardial_infarction_Sadowski_99)

    Citation

    1. Hargarten KM, Aprahamian C, Stueven HA, et al: ProphylacticLidlidocaine in the prehospital patient with chest pain of suspected cardiac origin. Annals of Emergency Medicine 1986; 15 (8): 881-885
    Search Terms: ?
    Contributor: Chris Ball and Musab Hayatli, November 1999
    Reviewer: Bruce Arroll

    Clinical Question.
    Patient chest pain
    Intervention or Exposure lignocaine, lidocaine
    Comparison no lidocaine, lignocaine
    Outcome death