EKG
Ventricular Fibrillation Management in the Adult
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Ventricular Fibrillation Management in the Adult
See Also
Cardiopulmonary Resuscitation
Reversible Causes of Cardiopulmonary Arrest
(
5H5T
)
Post-Cardiac Arrest Care
Management
Approach
ABC Management
CPR until
Defibrillator
available
Good quality
Cardiac Compressions
are critical for survival (
ROSC
)
Consider 5 cycles CPR (2 min) before defibrillating
Mechanical CPR devices (Lucas, Vest-CPR, Auto-pulse) are preferred if available
Defibrillation
options (single shock)
Manual biphasic: Device specific dose (120-200 J) or
Automated External Defibrillator
(AED) or
Monophasic 360 joules
Secure cardiopulmonary access
See
Cardiopulmonary Resuscitation
Hyperventilate with 100% oxygen
Endotracheal Intubation
Obtain
Intravenous Access
Cycles
Perform 5 cycles of CPR (30:2) for total of 2 minutes
Once
Advanced Airway
in place, give 8-10 breaths per minute (every 6-8 min) and compressions >100/minute asynchronously
Rotate compressors every 2 minutes
Re-evaluate rhythm with minimum interruption of
Cardiac Compressions
(<10 seconds)
Organized Electrical activity: Check for pulse
Non-shockable rhythm: See Other protocols
Asystole
Pulseless Electrical Activity
(PEA)
Shock
able rhythm: Defibrillate
Ventricular Fibrillation
Pulseless Ventricular Tachycardia
(V. fib or V. Tach)
Repeat
Defibrillation
as above after each cycle
Call clear
Compressions need not be interrupted if mechanical CPR device is in place
Administer medications once IV or
IO Access
obtained (see below)
Administer during
Cardiac Compressions
(between
Defibrillation
s)
Epinephrine
First dose after the second
Defibrillation
Repeat every 3-5 minutes
May substitute all
Epinephrine
doses (for at least 20 minutes) with a single
Vasopressin
dose once
Amiodarone
First dose after the third
Defibrillation
Repeat once after the fifth
Defibrillation
May substitute with
Lidocaine
only if
Amiodarone
unavailable
Refractory
Ventricular Fibrillation
(failed response to 3 or more
Defibrillation
attempts)
Move pads
Move anteroposterior
Defibrillation
pads to anterolateral placement (or vice versa)
Double Sequential
Defibrillation
Place
Defibrillation
pads in anteroposterior position and anterolateral position
Discharge both
Defibrillator
s simultaneously
Cheskes (2020) Resuscitation 150:178-84 [PubMed]
Management
Medications (after IV or
IO Access
obtained)
Adrenergic Medication
Vasopressin
40 Units IV for single, one time dose, replacing either the first or second
Epinephrine
dose OR
Epinephrine
1 mg IV push (repeat every 3-5 min) or
Do not use
Epinephrine
for 20 minutes after
Vasopressin
Avoid Escalating or high dose
Epinephrine
(e.g. 3 or 5 mg)
Antiarrhythmic
medication (choose one)
Amiodarone
(preferred)
Dose 1: 300 mg IV push
Dose 2: 150 mg IV push
Maximum cumulative dose: 2.2 grams in 24 hours
Requires pressure support after use
Lidocaine
(only use if
Amiodarone
is unavailable)
Contrasted with
Amiodarone
, not shown to improve survival
Dose 1: 1.0 to 1.5 mg/kg IV push
Dose 2: 0.5 to 0.75 mg/kg IV push
Maximum cumulative dose: 3 mg/kg
Consider adjunctive medications (specific indications)
Avoid
Sodium Bicarbonate
as does not improve survival (out of ECC guidelines as of 2010)
Magnesium Sulfate
Dose: 1-2 g IV
Indications
Irregular, Polymorphic VT (
Torsades de Pointes
)
Suspected
Hypomagnesemia
Management
Post
Return of Spontaneous Circulation
(
ROSC
)
Assess
Vital Sign
s
Support Airway and breathing
Consider medications
Infusion of
Antiarrhythmic
that converted rhythm
Pursue definititive management of underlying cause
Reversible Causes of Cardiopulmonary Arrest
(
5H5T
)
Initiate
Hypothermia
protocol
Improves longterm CNS recovery post-hypoxic event
Management
Example
Cycle 1
Perform 5 cycles of CPR (30:2) for total of 2 minutes
Obtain
IV Access
concurrent with CPR
Rhythm check and Defibrillate (Call 'clear' and <10 second cardiac compression interruption)
Rotate compressor
Cycle 2
Perform 5 cycles of CPR (30:2) for total of 2 minutes
Place
Advanced Airway
concurrent with CPR
Apply mechanical CPR device (e.g. Lucas, Vest-CPR, Auto-pulse) if available (<10 second CPR interruption)
Rhythm check and Defibrillate (Mechanical CPR device, such as Lucas, need not be stopped for
Defibrillation
)
Cycle 3
Perform CPR for 2 minutes (If
Advanced Airway
, give asynchronously 8-10 breaths per minute and >100 compressions/min)
Administer
Epinephrine
1 mg IV
Treat reversible cause (e.g. contact catheterization lab if
Acute Coronary Syndrome
suspected)
With mechanical CPR device in place, inter-hospital transport is viable despite lack of
ROSC
Rhythm check and Defibrillate
Cycle 4
Perform CPR for 2 minutes
Administer
Amiodarone
300 mg IV
Rhythm check and Defibrillate
Cycle 5
Perform CPR for 2 minutes
Administer
Vasopressin
40 U IV
Rhythm check and Defibrillate
Cycle 6
Perform CPR for 2 minutes
Administer
Amiodarone
150 mg IV
Rhythm check demonstrates organized rhythm (e.g.
Sinus Bradycardia
)
Cycle 7
Check for pulse (confirm not
Pulseless Electrical Activity
)
Amiodarone
maintenance to prevent recurrent
Arrhythmia
Initial: 1 mg/min for 6 hours
Next: 0.5 mg/min up to total cummulative dose not more than 2.2 grams
Post-
Resuscitation
See Induced
Therapeutic Hypothermia
See
Post-Cardiac Arrest Care
References
Cardiopulmonary Resuscitation
Guidelines
http://www.circulationaha.org
(2010) Guidelines for CPR and ECC [PubMed]
(2005) Circulation 112(Suppl 112):IV [PubMed]
(2000) Circulation, 102(Suppl I):86-9 [PubMed]
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