Esmolol Administration for the Treatment of Refractory Ventricular Fibrillation (original) (raw)
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ARYA atherosclerosis, 2013
Reperfusion ventricular fibrillation after aortic cross clamp is one of the important complications of open cardiac surgery and its prevention could reduce myocardial injuries. This study aimed to evaluate the efficacy of single dose of amiodarone or lidocaine by the way of pump circuit three minutes before aortic cross clamp release and compare the results with normal saline as placebo in a randomized double blinded controlled trial. One hundred fifty patients scheduled for first time elective coronary artery bypass graft surgery were randomly assigned to receive either single dose of amiodarone (150 mg), lidocaine (100 mg), or normal saline (5 ml) three minutes before aortic cross clamp release. The incidence of ventricular fibrillation and the need for reuse of drug were compared between these groups by chi-square, Student's t-test, Mann-Whitney test, and One-way ANOVA. SPSS software was used for statistical analysis. The incidence of ventricular fibrillation is higher in the...
Resuscitation, 2014
We compare the outcomes for patients who received esmolol to those who did not receive esmolol during refractory ventricular fibrillation (RVF) in the emergency department (ED). A retrospective investigation in an urban academic ED of patients between January 2011 and January 2014 of patients with out-of-hospital or ED cardiac arrest (CA) with an initial rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT) who received at least three defibrillation attempts, 300mg of amiodarone, and 3mg of adrenaline, and who remained in CA upon ED arrival. Patients who received esmolol during CA were compared to those who did not. 90 patients had CA with an initial rhythm of VF or VT; 65 patients were excluded, leaving 25 for analysis. Six patients received esmolol during cardiac arrest, and nineteen did not. All patients had ventricular dysrhythmias refractory to many defibrillation attempts, including defibrillation after administration of standard ACLS medications. Most receiv...
Interactive cardiovascular and thoracic surgery, 2008
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the administration of amiodarone or lidocaine in patients with refractory VT/VF after cardiac surgery results in successful cardioversion. Altogether more than 434 papers were found using the reported search, from which 23 articles were used to answer the clinical question. No randomized trials have been found in which amiodarone was studied in patients with refractory VF/VT after cardiac surgery. Recommendations on the use of amiodarone in patients with refractory VF/VT in both European and American 2005 Guidelines on Resuscitation are mainly based on expert consensus and are supported by a few randomized trials in patients with out-of-hospital cardiac arrest. We would therefore recommend that amiodarone is the first line drug that should be used in patients with refractory ventricular arrhythmias after cardiac surgery that persist after three failed attempts ...
International Journal of Advanced Research (IJAR), 2019
Background:Reperfusion ventricular fibrillation (VF) after aortic cross-clamp (ACC) release is one of the most common complications after Aortic valve surgery. Materials and methods:Eighty seven patients who had undergone Aortic valve surgery were assigned randomly to three groups (29 patients each). The lidocaine group received lidocaine with magnesium sulfate (mgso4) (100 mg lidocaine and 2g mgso4) in 25 ml isotonic saline, the amiodarone group received (300 mg amiodarone) diluted in 25 ml of an isotonic saline, and the control group received 25 ml normal saline by a pump circuit 3 min before ACC release. Anesthetic management, weaning protocol from cardiopulmonary bypass, were standardized. All the patients were monitored after the release of ACC and VF were recorded. Results:Incidence of VF after release of ACC was lower in the lidocaine with mgso4 group compared with the amiodarone and control group [6 (20.7%), 8 (27.6%) vs. 12 (41.4%)] but there was no statistically significant difference between all groups (P = 0.215). Also, the incidence of an atrioventricular block and bradycardia after release ACC was higher in the lidocaine mgso4 group compared with the amiodarone and control groups [7 (24.1%) vs. 4 (13.8%) and 3 (10.3%), respectively)] but there was no statistically significant difference between all groups (P = 0.331). Conclusion:The administration of lidocaine with mgso4 before the release of ACC reduced the incidence of VF. However, the administration of Lidocaine with mgso4 was associated with more transient atrioventricular block.
Lidocaine cardioplegia for prevention of reperfusion ventricular fibrillation
The Annals of Thoracic Surgery, 1993
Lidocaine addition to crystalloid cardioplegic solution for prevention of reperfusion ventricular fibrillation after the release of the aortic cross-clamp was studied in 50 patients undergoing coronary artery bypass grafting and in 30 patients undergoing mitral or aortic valve replacement. Twenty-six of the patients undergoing coronary artery bypass grafting received lidocaine, 100 mg/L of cardioplegia, whereas a control group of 24 patients received cardioplegia without lidocaine. In the group undergoing valve replacement, 14 patients received lidocaine cardioplegia and 16 patients served as control. In eperfusion ventricular fibrillation (VF) is a major R concern in patients undergoing open heart operations, despite the improvement in myocardial protection strategies. After the release of the aortic cross-clamp (ACC), VF is reported to occur in 74% to 96% of patients [1][2][3][4]. Reperfusion VF may result in increased myocardial wall tension, increased myocardial oxygen consumption, and impaired subendocardial blood flow [5, 61. Furthermore, defibrillation with direct-current (DC) countershock will result in myocardial injury [7]. Thus, it is advantageous to prevent the occurrence of reperfusion VF after release of the ACC.
Iranian Red Crescent Medical Journal, 2018
Background: The prevalence of ventricular fibrillation after removal of the aortic cross-clamp in patients undergoing coronary artery bypass surgery is about 74%-96%. Defibrillation shock and different types of agents are used to treat ventricular fibrillation (VF). Objectives: This study was aimed to compare the effects of combining Lidocaine + Magnesium Sulfate with Amiodarone + Magnesium Sulfate in the prevention of reperfusion-induced ventricular fibrillation. Methods: This randomized, double-blinded clinical study included 74 ASA class II and III patients undergoing coronary artery bypass grafting (CABG) in a university-affiliated hospital, Bandar Abbas, Iran, in the years 2015-2016. Patients were divided into two groups based on a random sample table of the lock. Both groups received Magnesium Sulfate through the cardiopulmonary bypass pump. Lidocaine 2% (100 mg) and Amiodarone (300 mg) were injected respectively to group Lidocaine + Magnesium Sulfate (LM) and group Amiodarone + Magnesium Sulfate (AM) patients before aortic cross-clamp release. The incidences of arrhythmias were recorded within 30 minutes after release of the aortic cross-clamp (ACC). Additionally, the defibrillation shocks (frequency and level of joules delivered), amount of inotrope agent, and the hemodynamic and arterial blood gas parameters were recorded up to 24 hours post operatively. Results: There was no significant difference between the two groups in terms of demographic characteristics, ejection fraction, and ASA class. The prevalence of ventricular fibrillation (VF) and atrial fibrillation (Af) 30 minutes after ACC release were 46.7% and 53.3% (P = 0.240) vs. 33.3% and 66.7% (P > 0.999); while, up to 24 hours post-operatively were 60% and 20.0% vs. 0.0% and 0.0% in groups LM and AM respectively. The number of defibrillations in the Lidocaine + Magnesium Sulfate group was significantly higher 57.9% vs. 25% in groups LM and AM respectively (P = 0.004). Conclusions: The use of Amiodarone + Magnesium Sulfate reduces the number of defibrillation following the release of the Aortic cross-clamp compared with Lidocaine + Magnesium Sulfate.
Effect of Esmolol on Cardiac Recovery after Cardiopulmonary Bypass Surgery
Introduction: During cardiopulmonary bypass (CPB) surgery , beta-blockers are generally avoided due to the concern of negative inotropic effects which may result in difficult weaning of patients. The present study was done to evaluate the effect of esmolol (a beta blocker) on recovery and rhythm of cardiac muscles during CPB. Material and Methods: Sixty patients of rheumatic heart disease undergoing CPB received either esmolol 1 mg/kg (Study group, 30 patients) or the same volume of saline (Control group, 30 patients) before removing aortic clamp. Recovery of patients was assessed in terms of heart auto re-beat ratio, ventricular fibrillation after primary re-beat, heart rate after constant re-beat, requirement of temporary perioperative pacemaker, requirement of vasoactive drugs during weaning from cardiopulmonary bypass, recovery time, posterior parallel time and total bypass time. Results: The mean age of patients in study and control group was 62.3±2.3 and 61.24± 2.32 years respectively. In esmolol treated group heart underwent re-beat automatically in 90% of patients, ventricular fibrillation after primary re-beat occurred in 6.66% patients, mean recovery time was 4.2±1.2 min, heart rate after steady re-beat was 50± 15 beats/min, only 16.66% patients needed increased dosage of vasoactive drugs and posterior parallel time was 25±8 min. In control group heart underwent re-beat automatically in 26.66% of patients, ventricular fibrillation after primary re-beat occurred in 40% patients, mean recovery time was 4.5±.3 min, heart rate after steady re-beat was 90±15 bits/min, only 50% patients needed increased dosage of vasoactive drugs and posterior parallel time was 30±9 min. Conclusion: In present study esmolol has shown that it can be helpful in cardiac recovery in patients undergoing cardiopul-monary bypass.