Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation (original) (raw)
Related papers
CJEM, 2019
Refractory ventricular fibrillation encountered during cardiac arrest has a mortality rate of 97%.1 As per the advanced cardiac life support (ACLS) guidelines, the management algorithm of ventricular fibrillation consists of chest compressions, epinephrine, defibrillation, and anti-arrhythmics.2 There have been reports describing the use of the fast-acting selective β-blocker, esmolol, and dual-sequential defibrillation in the management of ventricular fibrillation that is refractory to standard ACLS. We present a case of a 24-year-old male who had an out-of-hospital cardiac arrest, with refractory ventricular fibrillation despite high-quality cardiopulmonary resuscitation (CPR) and ACLS management. Along with standard ACLS, triple-sequential defibrillation was used to achieve return of spontaneous circulation (ROSC) after 82 minutes of downtime. An electrocardiogram (ECG) after ROSC showed an ST-elevation myocardial infarction (MI), and the patient underwent angiography showing a 1...
Esmolol Administration for the Treatment of Refractory Ventricular Fibrillation
Bezmialem Science, 2016
Ventricular fibrillation (VF) after releasing an aortic cross clamp in patients undergoing open heart surgery procedures is not rare. Ischemia-reperfusion injury after release of the aortic clamp, increased adrenergic tone, and insufficient protection of the myocardium are the possible causes. Amiodarone, lidocaine, and beta blockers have been added to the cardioplegia solutions as a preventive measure for reperfusion VF. We report a case of life-threatening, shock-resistant VF during the weaning period of a cardiopulmonary bypass (CPB) in a 61-year-old male who underwent a mitral valve repair surgery for mitral valve regurgitation. After several defibrillation attempts, refractory VF was turned to normal sinus rhythm shortly after ultra-short acting, beta blocking agent esmolol administration. CPB was terminated successfully following this. In conclusion, VF is still a major problem for clinicians and the treatment of refractory VF is not well defined. In contrast with the absence of the sufficient randomized controlled human studies, theoretically beta blockers could be a choice alternative for shock refractory VF.
Cureus, 2018
Refractory ventricular fibrillation is a rare condition seen in both in-hospital and out-ofhospital cardiac arrest. A 56-year-old male was identified to have refractory ventricular fibrillation after an in-hospital cardiac arrest with multiple unsuccessful standard defibrillation attempts that was converted with dual-sequential defibrillation (DSD) to normal sinus rhythm. Advanced cardiac life support (ACLS) is the most widely used algorithmic treatment approach for various cardiopulmonary emergencies but has yet to provide recommendations for the treatment of refractory ventricular fibrillation. DSD may be a viable treatment strategy for refractory ventricular fibrillation when ACLS recommendations are ineffective.
Successful treatment of refractory cardiac arrest by emergency physicians using pre-hospital ECLS
Resuscitation, 2012
Successful treatment of refractory cardiac arrest by emergency physicians using pre-hospital ECLS ଝ Sir, A 32-year-old man with no previous medical history experienced a cardiac arrest (CA), during a sporting session. A witness immediately performed CPR and called the emergency medical services (EMS). An AED was connected by bystanders and delivered one shock. After 10 min the patient returned to spontaneous circulation (ROSC) Simultaneously a mobile intensive care unit (MICU) arrived on scene and started specialized care. Shortly after ROSC the ventricular fibrillation (VF) recurred and advanced life support was initiated for this second CA according to international guidelines. 1 Despite this treatment persistent VF was observed. During CPR, signs of life were noted. After 10 min of unsuccessful resuscitation, the MICU and the EMS dispatching physicians decided that the patient was eligible for extra corporeal life support (ECLS). A recently created ECLS mobile team was dispatched to the scene. This team comprised 2 emergency physicians, and 2 paramedics, was equipped with a portable ECLS device (Maquet, Wayne, NJ, USA, Cardiohelp V3.2) and had been trained to set it up and transport patients to hospital. The ECLS insertion procedure was started after 30 min of unsuccessful resuscitation. The venous and arterial cannulae were respectively inserted within 5 min in the femoral area. Finally 60 min after the second CA ECLS was working,
Amiodarone for Resuscitation After Out-ofHospital Cardiac Arrest Due to Ventricular Fibrillation
Annals of Emergency Medicine, 2000
Background Whether antiarrhythmic drugs improve the rate of successful resuscitation after outof-hospital cardiac arrest has not been determined in randomized clinical trials. Methods We conducted a randomized, doubleblind, placebo-controlled study of intravenous amiodarone in patients with out-of-hospital cardiac arrest. Patients who had cardiac arrest with ventricular fibrillation (or pulseless ventricular tachycardia) and who had not been resuscitated after receiving three or more precordial shocks were randomly assigned to receive 300 mg of intravenous amiodarone (246 patients) or placebo (258 patients). Results The treatment groups had similar clinical profiles. There was no significant difference between the amiodarone and placebo groups in the mean (±SD) duration of the resuscitation attempt (42±16 and 43±16 minutes, respectively), the number of shocks delivered (4±3 and 6±5), or the proportion of patients who required additional antiarrhythmic drugs after the administration of the study drug (66 percent and 73 percent). More patients in the amiodarone group than in the placebo group had hypotension (59 percent vs. 48 percent, P=0.04) or bradycardia (41 percent vs. 25 percent, P=0.004) after receiving the study drug. Recipients of amiodarone were more likely to survive to be admitted to the hospital (44 percent, vs. 34 percent of the placebo group; P=0.03). The benefit of amiodarone was consistent among all subgroups and at all times of drug administration. The adjusted odds ratio for survival to admission to the hospital in the amiodarone group as compared with the placebo group was 1.6 (95 percent confidence interval, 1.1 to 2.4; P=0.02). The trial did not have sufficient statistical power to detect differences in survival to hospital discharge, which differed only slightly between the two groups. Conclusions In patients with out-of-hospital cardiac arrest due to refractory ventricular arrhythmias, treatment with amiodarone resulted in a higher rate of survival to hospital admission. Whether this benefit extends to survival to discharge from the hospital merits further investigation.
Heart Rhythm, 2004
OBJECTIVES The aims of this study were to describe the trends of ventricular fibrillation (VF) out-of-hospital cardiac arrest in Rochester, Minnesota, since 1985 and to determine coexistent trends in implantable cardioverter defibrillator (ICD) placement and termination of potentially lethal ventricular arrhythmias that might explain, at least in part, a declining incidence trend. BACKGROUND The incidence of VF out-of-hospital cardiac arrest treated by emergency medical services (EMS) personnel has declined over the past decade. Because VF out-of-hospital cardiac arrest occurs primarily in the setting of severe coronary artery disease, primary and secondary prevention strategies may account in part for the decline. In particular, ICD use in large primary and secondary prevention clinical trials in patients at high risk of sudden death has demonstrated that these devices improve survival. METHODS All residents of the City of Rochester, Minnesota, who presented with a VF out-of-hospital cardiac arrest from 1985 to 2002, identified and treated by EMS, were included in the study. In addition, residents of the City of Rochester who received their first ICD implant from 1989 to 2002 were identified. From the ICD records, general demographics, etiology of heart disease, comorbid medical disease, and indication for ICD placement were abstracted. Follow-up data obtained from this population included ICD shocks, the underlying rhythm disturbance, and death. RESULTS The overall incidence of EMS-treated VF out-of-hospital cardiac arrest in Rochester during the study period was 17.1 per 100,000 [95% confidence interval (CI) 15.1-19.4]. The incidence has decreased significantly (P Ͻ 0.001) over the study period: 1985-1989: 26.3/100,000 (95% CI 21.
Circulation, 2006
Background— The most recent resuscitation guidelines have sought to improve the interface between defibrillation and cardiopulmonary resuscitation; the survival impact of these changes is unknown, however. A year before issuance of the most recent guidelines, we implemented protocol changes that provided a single shock without rhythm reanalysis, stacked shocks, or postdefibrillation pulse check, and extended the period of cardiopulmonary resuscitation from 1 to 2 minutes. We hypothesized that survival would be better with the new protocol. Methods and Results— The present study took place in a community with a 2-tiered emergency medical services response and an established system of cardiac arrest surveillance, training, and review. The investigation was a cohort study of persons who had bystander-witnessed out-of-hospital ventricular fibrillation arrest because of heart disease, comparing a prospectively defined intervention group (January 1, 2005, to January 31, 2006) with a histo...
Resuscitation, 1997
Aim: To describe rhythm changes during the initial phase of resuscitation from ventricular fibrillation in relation to the interval between collapse and defibrillation, to survival and to bystander-initiated cardiopulmonary resuscitation (CPR). Patients: All patients who suffered out-of-hospital cardiac arrest between 1980 and 1992, who were reached by the emergency medical service system (EMS), in whom resuscitation attempts were initiated and who were found in ventricular fibrillation. Results: In all, 1216 patients were included in the study. Among patients who converted to a pulse-generating rhythm after the first defibrillation (n =119) were 56% discharged from hospital as compared with 6% among patients who converted to asystole. The corresponding figures after the third defibrillation were 49% and 2%, respectively, and after the fifth defibrillation 28% and 7%, respectively. Among patients in whom the first defibrillation took place less than 5 min after collapse, 28% directly converted to a pulse-generating rhythm as compared with 3% when the first defibrillation took place 12 min or more after collapse. Conclusion: Among patients who suffer out-of-hospital cardiac arrest and are found in ventricular fibrillation, there is a strong relationship between survival and initial rhythm changes after defibrillation. These rhythm changes are directly related to the interval between collapse and the first defibrillation.