Compared with no antiarrhythmic medication, lidocaine did not consistently increase a return of spontaneous circulation after defibrillation and was not asso- ciated with improvement in survival to hospital In prospective, blinded, RCTs, lidocaine was less effective than amiodarone in improving hospital admission rates after out-of- hospital cardiac arrest due to shock-refractory VF or polymorphic VT; but there were no differences between the 2 medications in survival to hospital However, in the subset of patients with witnessed SCA due to initial shock- refractory VF or pulseless VT, a subgroup analysis showed that survival to hospital discharge with lidocaine was better than with placebo.S6-5,S6-42 8. In a large meta-analysis of antiarrhythmic medi- cations in the setting of AMI, beta blockers were associated with a significant reduction Beta blockers can be effective in suppressing recurrent VF in patients with recent MI, with an associated improvement in 9. In patients with recurrent VT/VF (VT/VF storm) in the setting of a recent MI that is refractory to ami- odarone and/or lidocaine and repeated cardiover- sion, administration of a beta blocker has been shown to improve survival at 1 week. For those who did not survive, mortality was mostly due to recurrent VF. Survival at 1 year was also better in those treated with a beta blocker.S6-17,S6-18 Other measures to reduce sympathetic tone including sedation and general anesthesia are also often used. 10. Epinephrine produces beneficial effects in patients during cardiac arrest, primarily because of its alpha-adrenergic (ie, vasoconstrictor) effects.S6-1 These alpha-adrenergic effects can increase coronary and cerebral perfusion pressure during CPR. 