Pediatric Ventricular Fibrillation Medication

Updated: Jan 29, 2015
  • Author: Elizabeth A Stephenson, MD, MSc; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Medication

Medication Summary

Patients who have been resuscitated from ventricular fibrillation arrests should be evaluated for risk of recurrence. If ventricular fibrillation was secondary to degeneration of another arrhythmia that may recur, medication and other therapies (eg, radiofrequency catheter ablation [RFCA], pacemaker placement, automatic ICD [AICD], surgery) may be aimed at prevention of that arrhythmia. These potentially degenerating arrhythmias should be considered, particularly in patients without evidence of severe electrolyte disturbance, metabolic derangement, hypoxia, myocardial infarction, or drug toxicity. Medications to treat such arrhythmias are discussed in Ventricular Tachycardia.

Some evidence suggests that vasopressin may play a role in the treatment of adult shock-refractory ventricular fibrillation; however, the safety and efficacy of this drug in children has not been evaluated.

A retrospective study by Valdes et al indicated that in children who suffer ventricular fibrillation or pulseless ventricular tachycardia while inhospital, lidocaine, but not amiodarone, can increase the likelihood of return of spontaneous circulation (ROSC) and 24-hour survival. The study involved 889 pediatric patients, including 171 children (19%) who received amiodarone and 295 patients (33%) who were treated with lidocaine, as well as 82 patients (9%) who received both drugs. Although only lidocaine was found to increase the rate of ROSC and 24-hour survival, neither drug improved the rate of survival to hospital discharge. [21]

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Antiarrhythmic agents

Class Summary

These agents alter the electrophysiologic mechanisms responsible for arrhythmia. Use during cardiac arrest follows administration of epinephrine and attempted defibrillation.

Amiodarone (Cordarone)

May inhibit AV conduction and sinus node function. Prolongs action potential and refractory period in myocardium and inhibits adrenergic stimulation.

Lidocaine (Xylocaine)

Class IB antiarrhythmic agent that increases electrical stimulation threshold of the ventricle, suppressing automaticity of conduction through the tissue. Consider as alternate treatment for ventricular fibrillation or pulseless ventricular tachycardia.

Magnesium sulfate

Used for suspected hypomagnesemia or torsade de pointes. Consider use in refractory ventricular tachycardia following lidocaine.

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Vasopressors

Class Summary

Patients most likely to adequately respond are those in whom physiologic parameters (eg, urine flow, myocardial function, blood pressure) have not profoundly deteriorated.

Epinephrine (Adrenalin)

Used for asystole or pulseless arrest. Also used for symptomatic bradycardia unresponsive to oxygen and ventilation.

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