Lignocaine Policy

16th April 04
does anyone have a lignocaine policy (cardiac/post VT/VF) they are willing to share? Lit. search gives a range of rates and duration for infusions. I was hoping to get something a bit more specific in terms of prescriptive rates and duration etc. for clinicians to use post arrhythmia.
regards,

CNC Critical Care Rural

16th April 04
I would suggest contacting the ACCCN ALS committee either the national or state subcommittee - they have a good grasp on current policy and protocol and may be able to assist with some relevant information.
contact via the web site www.acccn.com.au or acccn@acccn.com.au or nsw@acccn.com.au or 0297450874 NSW

Statewide Coordinator,
Critical Care Services Planning
NSW Health Department

18th April 04
There is no place for lignocaine for 'cardiac/post VT/VF'.
The only indications for lignocaine are
1. local anaesthesia and
2. neurological decompression illness

Staff Specialist 1Tertiary Referral

20th April 04
Whilst I may not be quite as "concrete" as the previous writer- I simply cannot remember the last patient with VF/VT I gave lignocaine too... I suppose I would probably use it first line in a thyrotoxic patient with prolonged QT... although probably over-drive pacing would be an alternative to consider in a similar manner to the treatment for torsade...

P.S. How do you use it for indication 2

Director of Intensive Care, Level 5 (JFICM 2) Rural

20th April 04
Must agree whole heartedly with Staff Specialist 1 t wrt lignocaine use in VT/VF. However,my problem when recently trying to convince others to change resuscitation standing orders is the fact you are trying to argue against the existing policy statements and guidelines of the ARC which still state: consider lignocaine 1 - 1.5mg/kg for the treatment of VT?VF.

Staff Specialist 2, Level 5 (JFICM2)

20th April 04
The ARC is a bit of a slow moving beast!!!!!!!!!!
Lignocaine is also still in the 2000 AHA guidelines, but it is down the list ("consider the use of .....", and is only grade 2b level of evidence). There are other antiarrhythmics higher up the list and amiodarone is on the top, followed by magnesium, before you would even consider lignocaine for resistant VT. Magnesium is drug of choice for polymorphic VT or 'torsade des pointes'.
How many thyrotoxic patients with prolonged QT does your ICU get??!!!!!!
Staff Specialist 1 Tertiary Referral

20th April 04
Indication 2: neurological DCI.
Quite strong evidence, particularly from Simon Mitchell who did his PhD on this subject while working at the Slark Hyperbaric Unit in Auckland. As well as DCI he also looked at 'subclinical' gas embolism in a human cardiopulmonary bypass model and demonstrated a role for IV lignocaine there. Role is mainly from the "membrane stabilising" effects - DCI does not so much damage neural tissue directly, but rather the gas bubble sets off a chain reaction of lipid peroxidation and cheotaxis that leads to the secondary neurological damage.
Primary use is for patients who are a long way from decompression (12 - 24 hours or more to retrieval is quite common in the Pacific Islands). IV lignocaine is simple and relatively safe, and allows ongoing observation and resuscitation of the patients. Alternatives such as in water recompression on oxygen have their proponents, and work well, but the margin of safety is negligible and if one of these patients loses consciousness or has an oxygen induced seizure then he dies. NSAIDS proably also have a role here and I beleive there is a multicentre Australasian PRCT underway.
If you are only a couple of hours from a recompression chamber there is probably no point as pressure is the ultimate treatment ("premendo sonare")

Staff Specialist 1Tertiary Referral

22/04/04
Well, I don't JUST work in Orange Ian, so if you combine Orange, Bathurst and Dubbo figures, probably about as many as Nepean!
On a more serious note, we do have a number of patients with thyroid disease or amiodarone induced lung toxicity, neither of which would STOP me from using amiodarone in the acute setting, but would certainly make me think twice or use lignocaine first!
Director of Intensive Care, Level 5 (JFICM 2) Rural