Ventricular Fibrillation in Emergency Medicine Follow-up

Updated: Dec 30, 2015
  • Author: Keith A Marill, MD; Chief Editor: Erik D Schraga, MD  more...
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Follow-up

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. Furthermore, thrombolytic therapy has not proven beneficial when administered unselectively to all cardiac arrest patients. [40] Cardiology consultation is warranted for all survivors of cardiac arrest, and efforts at revascularization should be attempted selectively, as indicated. [41, 42]

Patients who remain comatose post resuscitation may benefit from 12-24 hours of controlled hypothermia therapy at 32-34 degrees Centigrade (89.6-93.2 degrees Fahrenheit) or at least euthermia and avoidance of fever. Hypothermia can be accomplished with chemical sedation and paralysis to prevent shivering and an external cooling blanket or ice. Hypothermia therapy improved both neurologic outcome and mortality in two initial trials, but this result was not observed in a more recent study. [43, 44, 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. Consider administering a beta-adrenergic blocking agent during acute myocardial infarction unless contraindicated by bradycardia, heart block, congestive heart failure, or reactive airway disease.

For patient education information, see the Heart Health Center and Healthy Living Center, as well as Cardiopulmonary Resuscitation (CPR).

The National Library of Medicine's Medline Plus Website is another invaluable resource.

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