Two previous small, randomized trials showed significantly higher rates of return of spontaneous circulation and hospital admission with amiodarone than with placebo or lidocaine after shock-refractory out-of-hospital cardiac arrest.7,8 The current trial, which was larger and performed in the context of well-executed CPR, showed similar benefits with respect to shortterm outcomes, but with both drugs. The time
to treatment with these drugs was typically late across all the trials, averaging 19 minutes from the initial call to EMS in this trial and 21 to 25 minutes in the others.7,8 Such delays may attenuate the effectiveness of antiarrhythmic interventions as patients progress to the metabolic phase of out-of-hospital cardiac arrest, when cellular injury and physiological derangements may be irreversible despite restored circulation