If amiodarone is unavailable, which drug may be used as an alternative in refractory VF/pVT in children?

• A. Epinephrine
• B. Lidocaine
• C. Magnesium sulfate
• D. Adenosine

Answer: (B)

In pediatric resuscitation, after defibrillation attempts have failed in a child with ventricular fibrillation or pulseless ventricular tachycardia, an antiarrhythmic is given. If amiodarone isn’t available, lidocaine serves as a suitable alternative. Lidocaine is a sodium channel blocker (class IB) that reduces automaticity and excitability in the ventricles, especially in ischemic or traumatized tissue often encountered during cardiac arrest. This helps suppress ongoing ventricular arrhythmias and supports defibrillation effectiveness.

Other drugs in this scenario don’t fit as antiarrhythmics for VF/pVT. Epinephrine is primarily a vasopressor to maintain perfusion during CPR, not an antiarrhythmic. Magnesium sulfate is used for torsades de pointes or specific electrolyte disturbances, not general VF/pVT. Adenosine is used for supraventricular tachycardias, not ventricular rhythm disturbances. Li docaine thus provides an effective alternative when amiodarone cannot be used.