Is lidocaine used in pediatric cardiac arrest? If yes, what dose?

• A. No; lidocaine is never used in pediatric arrest.
• B. Yes; 0.5-0.75 mg/kg IV/IO; may repeat with a smaller second dose
• C. Yes; 1 mg/kg IV/IO, may repeat with a smaller second dose
• D. Yes; 2 mg/kg IV/IO; no repetition

Answer: (C)

Lidocaine can be used in pediatric cardiac arrest as an antiarrhythmic when recurrent ventricular arrhythmias (like VT/VF) persist and amiodarone is not available or effective. The best dosing approach is an initial IV or IO bolus of 1 mg/kg, with the option to repeat a smaller dose of 0.5 mg/kg IV/IO if the rhythm recurs, keeping the total dose around 3 mg/kg or less. This pattern provides additional antiarrhythmic effect while limiting toxicity. The option with 2 mg/kg and no repetition is higher than recommended and ignores the safe second-dose option, while the choice suggesting no use of lidocaine contradicts its role as an approved alternative in pediatric arrests. The choice that specifies a second dose of 0.5–0.75 mg/kg doesn’t align with the standard recommendation of 0.5 mg/kg for the repeat dose.