Ventricular Fibrillation in Emergency Medicine Follow-up

  • Author: Keith A Marill, MD; Chief Editor: David FM Brown, MD   more...
 
Updated: Jun 23, 2011
 

Further Inpatient Care

  • Resuscitated patients must be admitted to an intensive care unit and monitored because of high risk of a recurrence.
    • They require stabilization and monitoring for possibility of a coexistent emergency or complication.
    • Evaluation of ischemic injury to the CNS, myocardium, and other organs is essential.
    • Patients typically have an underlying etiology that must be investigated and treated.
  • Up to approximately half of cardiac arrest survivors have evidence of an acute MI. Both emergent thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA) have been used to treat these patients; however, CPR for greater than 10 minutes is considered a relative contraindication to thrombolysis. Emergent cardiology consultation is warranted for all survivors of cardiac arrest, and efforts at revascularization should be attempted, if indicated.[29, 30]
  • Patients who remain comatose post resuscitation benefit from 12-24 hours of controlled hypothermia therapy at 32-34 degrees Centigrade (89.6-93.2 degrees Fahrenheit). This can be accomplished with chemical sedation and paralysis to prevent shivering and an external cooling blanket or ice. Hypothermia therapy improves both neurologic outcome and mortality.[31, 32]
  • Automated implantable defibrillators (AICDs) are recommended for patients at risk for recurrent VF because they effectively provide early defibrillation. Patients with VF arrest who receive AICDs have improved survival compared with those receiving only medications. However, patients with AICDs may also require oral antidysrhythmic therapy to minimize recurrent device activation.
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Deterrence/Prevention

  • In the setting of acute myocardial infarction, beta-adrenergic blocking therapy with agents such as metoprolol decrease the likelihood of ventricular dysrhythmias including ventricular fibrillation, and they lower overall mortality. Administer a beta-adrenergic blocking agent during acute myocardial infarction unless contraindicated by bradycardia, heart block, congestive heart failure, or reactive airway disease.
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Complications

  • CNS ischemic injury
  • Myocardial injury
  • Postdefibrillation arrhythmias
  • Aspiration pneumonia
  • Defibrillation injury to self or others
  • Injuries from CPR and resuscitation
  • Skin burns
  • Damage to implanted electronics (eg, AICD, pacemaker)
  • Death
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Prognosis

  • The prognosis for survivors of VF strongly depends on the time elapsed between onset and medical intervention. Early defibrillation often makes the difference between long-term disability and functional recovery.
  • Postresuscitation death and disability after successful resuscitation directly correlate with the amount of CNS damaged during the event. Without intervention, by 4-6 minutes after onset of VF, the prognosis is poor. Few survive when VF lasts more than 8 minutes without intervention.
  • The reported rate of survival from VF in the community varies from 4-33%. Survival is worst in dense urban and sparse rural areas, principally due to prolonged EMS response times.
  • AICD implantation is the primary treatment of survivors of VF. Antidysrhythmic and beta-adrenergic blocking medicines may also be helpful to prevent VF recurrence. While these interventions lower the risk of sudden dysrhythmic death, the AICD in particular does not prevent or retard the progressive congestive heart failure that is often present in these patients.
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Patient Education

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Contributor Information and Disclosures
Author

Keith A Marill, MD  Faculty, Department of Emergency Medicine, Massachusetts General Hospital; Assistant Professor, Harvard Medical School

Keith A Marill, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Medtronic Ownership interest None; Cambridge Heart, Inc. Ownership interest None; General Electric Ownership interest None

Coauthor(s)

A Antoine Kazzi  MD, Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Mazen K Khalil, MD  Post Doctoral Research Fellow, Department of Cell Biology, Lerner Research Institute, Cleveland Clinic Foundation

Mazen K Khalil, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Aaron A Bright, MD  Assistant Professor of Clinical Emergency Medicine, Department of Emergency Medicine, LAC+USC Medical Center, Keck School of Medicine of the University of Southern California

Aaron A Bright, MD is a member of the following medical societies: American College of Emergency Physicians and Los Angeles County Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven A Conrad, MD, PhD  Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center

Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gary Setnik, MD  Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School

Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position; ProceduresConsult.com Royalty Other

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Ventricular fibrillation. Rapidly recurrent despite electrical biphasic defibrillation. Notice that recurrence begins after completion of the T wave and is not due to an R-on-T phenomenon in this case. This episode of ventricular fibrillation (VF) occurred in the emergency department and was present for less than 30 seconds prior to defibrillation, hence the course morphology. Also an undulating amplitude suggestive of torsades de pointes was present; however, the QT interval during sinus rhythm was normal, and the only known predisposing factors for tachydysrhythmia were newly diagnosed coronary artery disease with acute right coronary artery occlusion and a history of rheumatoid pericarditis.
 
 
 
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