Unfortunately, some cases of VF are refractory to multiple attempts at defibrillation, despite the additional use of the anti-arrhythmic Amiodarone. 2016 Sep 106:14-7.Įlectrical defibrillation, long the mainstay of treatment for ventricular fibrillation (VF), often successfully converts the heart to a sinus rhythm with return of spontaneous circulation (ROSC). Dual defibrillation in out-of-hospital cardiac arrest: A retrospective cohort analysis. 2016 Nov 108:82-86.Īrticle 4: Ross EM, Redman TT, Harper SA, Mapp JG, Wampler DA, Miramontes DA. Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest. 2016 Oct 107:150-5.Īrticle 3: Cortez E, Krebs W, Davis J, Keseg DP, Panchal AR. Refractory ventricular fibrillation treated with esmolol. 2014 Oct 85(10):1337-41.Īrticle 2: Lee YH, Lee KJ, Min YH, Ahn HC, Sohn YD, Lee WW, Oh YT, Cho GC, Seo JY, Shin DH, Park SO, Park SM. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation. No additional, higher quality studies were found among these.Īrticle 1: Driver BE, Debaty G, Plummer DW, Smith SW. An additional search was conducted using the strategy “refractory ventricularfibrillation AND (“dual defibrillation” or “sequential defibrillation”)” ( ) which resulted in 6 articles. PubMED was searched using the strategy “refractory ventricular fibrillation AND esmolol” ( ) which resulted in 9 citations, from which the PGY-1 article was chosen. Three of the articles (PGY-2, PGY-3, and PGY-4) were selected from the above referenced post on the topic at RebelEM’s website. Outcome: ROSC, survival to hospital admission, survival to discharge, and neurologically intact survival Population: Adult patients with refractory ventricular fibrillation or pulseless ventricular tachycardia Being wary of other’s opinions, and being adept at appraising the medical literature yourself, you perform your own literature search and begin evaluation the evidence on your own. The authors evaluate the evidence for esmolol and dual sequential defibrillation. You later begin searching for answers online, and stumble upon a write-up from R.E.B.E.L EM ( ) on this very topic. You begin to wonder if there are additional medicaitons or maneuvers for patients in refractory v-fib. When the patient remains in v-fib after two additional attempts, you and the attending exchange a, “Well, what now?” look. Two mintes later, the patient remains in v-fib. You immediately attempt defibrillation for a third time, with no change in the patient’s condition, and give an additional 150 mg of amiodarone. They have attempted defibrillation twice, have given three rounds of epinephrine, and have given 150 mg of amiodarone, all with no change in rhythm. EMS reports the patient was in V-fib on their arrival about 15 minutes earlier. The patient arrives with a King tube in place, in ventricular fibrillation. You prep the room and discuss the plan with the team, emphasizing high-quality CPR with minimal interruptions. You’re working a busy TCC shift one weekend when you get a page that EMS is bringing in a fiftyish year old man in cardiac arrest.
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