A case of refractory ventricular fibrillation successfully treated with low-dose esmolol

Current advanced cardiac life support (ACLS) guidelines for the management of ventricular fibrillation (VF) and pulseless ventricular tachycardia is defibrillation. However, refractory VF, which is defined as VF that persists despite three defibrillation attempts, is challenging for all ACLS provide...

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Published inBMJ case reports Vol. 12; no. 3; p. e228208
Main Authors Hwang, Charles W, Gamble, Ginger, Marchick, Michael, Becker, Torben K
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 01.03.2019
BMJ Publishing Group
SeriesCase Report
Subjects
Adrenergic beta-1 Receptor Antagonists - therapeutic use
Anesthesia
Cardiac arrhythmia
Cardiopulmonary resuscitation
Cardiovascular disease
Case reports
Coronary vessels
CPR
Defibrillators
Electrocardiography
Heart attacks
Humans
Male
Middle Aged
Pain
Propanolamines - therapeutic use
Quality
Reminder of Important Clinical Lesson
Treatment Outcome
Ventricular Fibrillation - drug therapy
resuscitation
cardiovascular system
arrhythmias
intensive care
emergency medicine
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Summary:Current advanced cardiac life support (ACLS) guidelines for the management of ventricular fibrillation (VF) and pulseless ventricular tachycardia is defibrillation. However, refractory VF, which is defined as VF that persists despite three defibrillation attempts, is challenging for all ACLS providers; the best resuscitation strategy for patients that persist in refractory VF remains unclear. We report on a 51-year-old man who presented to the emergency department with chest pain and subsequently went into witnessed VF cardiac arrest. Despite standard ACLS management consisting of high-quality cardiopulmonary resuscitation, serial epinephrine and serial defibrillation, the return of spontaneous circulation (ROSC) was unable to be achieved. Double sequential defibrillation (DSD) was attempted multiple times unsuccessfully. After administration of low-dose esmolol, he immediately achieved ROSC. DSD and β-blockade are increasingly recognised in the literature and practice for refractory VF. However, to the best of our knowledge, this is the first case of refractory VF that responded to low-dose esmolol β-blockade.
Bibliography:ObjectType-Case Study-2
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2018-228208