First Report of Survival in Refractory Ventricular Fibrillation After Dual-Axis De brillation and Esmolol Administration

Abstract

There is a subset of patients who suffer a witnessed ventricular fibrillation (VF) arrest and despite receiving reasonable care with medications (epinephrine and amiodarone) and multiple defibrillations (3+ attempts at 200 joules of biphasic current) remain in refractory VF (RVF), also known as electrical storm. The mortality for these patients is as high as 97%. We present the case of a patient who, with a novel approach, survived RVF to outpatient follow up.

Beyond the Limit: Double Sequential Defibrillation as an Alternative Therapy for Refractory Ventricular Fibrillation

“…The outcomes of this case suggest the DSD may be of benefit in terminating refractory VF and achieving temporary or sustained ROSC, but the benefit of achieving temporary or sustained ROSC in refractory VF should be weighed against ischemic burden and progressive myocardial dysfunction imposed during resuscitation [26,27]. Our case is similar to previously described cases in which the patients have remained in refractory VF to multiple SD shocks before receiving DSD [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Likewise, we find similarities between the outcome in this case and the results described by Cabañas et al on the first case series published on DSD in OHCA.…”

“…Several case reports and case series have been published in recent years supporting the use of DSD as an alternative treatment for refractory VF as there appears to be a trend of promising outcomes [10][11][12][16][17][18][19][20][21][22][23][24]. Coronary artery disease (CAD) is the most common reversible cause in patients with VF/pVT OHCA [25].…”

“…There are currently no firm guidelines regarding the treatment of refractory VF. Double sequential defibrillation (DSD) is an approach that has been proposed as an alternative treatment for refractory VF as there appears to be a trend of promising outcomes, including termination of refractory VF, sustained ROSC, increased short term survival and favorable outcomes to hospital discharge [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. We report a case of prolonged resuscitation of an 72-year-old man who developed pulseless ventricular tachycardia (pVT) that progressed to refractory VF terminated by DSD.…”

Epinephrine-induced electrical storm after aortic surgery

“…Rapid treatment of ES is imperative with the time between ES recognition and treatment linearly related to increasing mortality. [8] Nademanee et al . reported on 49 ES cases divided into two treatment groups: Anti-catecholamine treatment once stabilized (sympathetic blockade) versus standard guideline-driven approach and found the former demonstrating significantly improved survival.…”

Saved by the pump: Two successful resuscitations utilising emergency department-initiated extracorporeal cardiopulmonary resuscitation in South Africa

“…This patient presented with an electrical storm, an almost universally lethal entity. Boehm et al [16] described the first case of an electrical storm in which dual-axis defibrillation and esmolol administration were successfully used in restoring a perfusing rhythm. It is important to note that dual-axis defibrillation falls outside the current recommendations and esmolol is not widely available in SA, and this method may therefore have limited utility unless better evidence become available.…”