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Triple-sequential defibrillation for refractory ventricular fibrillation in a 24-year-old male out of hospital cardiac arrest

  • Adam Bignucolo (a1), Adam Parent (a1), Mark Dube (a1), John Kusnierczyk (a1), Dominique Ansell (a1) and Robert Ohle (a1)...

Summary

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 100% occlusion of his left anterior descending artery. Following management of his coronary artery disease, he was discharged from the hospital 16 days later and was neurologically intact.

Copyright

Corresponding author

Correspondence to: Dr. Robert Ohle, Health Science North, 41 Ramsey Lake Rd, Sudbury, ON P3E 5J1; Email: Robert.ohle@gmail.com

References

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1.Bourque, D, Daoust, R, Huard, V, Charneux, M. β-Blockers for the treatment of cardiac arrest from ventricular fibrillation? Resuscitation 2007;75(3):434–44.
2.Link, MS, Berkow, LC, Kudenchuk, PJ, et al. Part 7: adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132(18_suppl_2):S444-S64.
3.Lee, YH, Lee, KJ, Min, YH, et al. Refractory ventricular fibrillation treated with esmolol. Resuscitation 2016;107:150–5.
4.Stiell, IG, Walker, RG, Nesbitt, LP, et al. : BIPHASIC Trial: a randomized comparison of fixed lower versus escalating higher energy levels for defibrillation in out-of-hospital cardiac arrest. Circulation 2007;115(12):1511–7.
5.Davis, M, Schappert, A, Van Aarsen, K, et al. P029: A descriptive analysis of defibrillation vector change for prehospital refractory ventricular fibrillation. CJEM 2018;20(S1):S67–S.

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Supplementary materials

Bignucolo et al. supplementary material
Table S1 and Figures S1-S3

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Triple-sequential defibrillation for refractory ventricular fibrillation in a 24-year-old male out of hospital cardiac arrest

  • Adam Bignucolo (a1), Adam Parent (a1), Mark Dube (a1), John Kusnierczyk (a1), Dominique Ansell (a1) and Robert Ohle (a1)...

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