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  • Title: Meta-analytic evidence against prophylactic use of lidocaine in acute myocardial infarction.
    Author: Hine LK, Laird N, Hewitt P, Chalmers TC.
    Journal: Arch Intern Med; 1989 Dec; 149(12):2694-8. PubMed ID: 2688587.
    Abstract:
    Although lidocaine prophylaxis reduces the incidence of ventricular fibrillation during acute myocardial infarction (AMI), randomized control trials (RCTs) have not demonstrated any significant mortality effect of this therapy. We conducted a meta-analysis of 14 RCTs of lidocaine prophylaxis during AMI to detect any mortality effect. Six prehospital- and eight hospital-phase RCTs that randomized totals of 7656 and 1407 patients, respectively, were selected and reviewed in a blinded fashion. Mortality data were evaluated according to therapy type, reporting interval, and patient category. The prehospital-phase RCTs showed no meaningful mortality effect (risk difference, 0.0184; 95% confidence interval, -0.048 to +0.012). The hospital-phase RCTs showed a statistically significant increase in mortality during the treatment period for lidocaine recipients (risk difference, 0.029; 95% confidence interval, +0.004 to +0.055). These results confirm that lidocaine administered to monitored patients during the prehospital phase of AMI will not reduce mortality by a clinically important amount and suggest that lidocaine administered in the hospital phase of monitored, uncomplicated AMI may increase mortality among recipients with proved AMI.
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