Background: In the United States 424,000 out of hospital cardiac arrests occur per year with a 10.4% overall survival rate.1 Refractory Ventricular Fibrillation (RVF) is a complication of cardiac arrest and has varying definitions in the literature but is commonly defined as ventricular fibrillation that does not respond to, or resists, three or more defibrillation attempts.2,3Although the estimated incidence of refractory ventricular fibrillation is 0.5-0.6 per 100,000 of the population, some authors report that 10-25% of cardiac arrest cases could develop RVF or recurrent VF.3-5 Patients who experience RVF during their cardiac arrest have a mortality of up to 97%.6,7 Several case reports have shown success with excellent neurologic outcomes in terminating RVF using dual defibrillation after failure of traditional Advance Cardiac Life Support (ACLS) measures.8-12 It is important to note and distinguish that dual defibrillation can either be simultaneous or sequential depending on the duration of the defibrillation potential as well as the intershock interval between the two defibrillator shocks.9-13 The terms “sequential” and “simultaneous” are often used interchangably due to the lack of accurately measuring pulse intervals when performing dual defibrillation in the actual clinical environment. The authors of this review utilize the term dual sequential defibrillation (DSD). They present a case of RVF in a patient with cardiac arrest, on whom DSD was successful in reversion to sinus rhythm and provide a thorough review of similar cases in the literature. Read more →
Tag Archive for: Resuscitation
Background: POCUS has become a powerful tool in the evaluation of critically ill patients in the ED. However, in patients with cardiac arrest, the use of POCUS has been shown to significantly increase the duration of pauses. This is concerning as high quality CPR with minimal interruptions is one of the keys to maximizing ROSC and survival with good neurologic outcomes. Recently, I had the chance to interview the lead author of the Cardiac Arrest Sonographic Assessment (CASA Exam) on REBEL Cast Ep 57 and on that episode we discussed a follow up study, which has finally been published in Resuscitation 2018. Read more →
Background:There is a lack of high quality RCTs investigating optimal airway management in patients with out-of-hospital cardiac arrest (OHCA). The majority of evidence comes from observational studies and expert opinion. The observational trials have consistently favored basic airway management (i.e. BVM) over tracheal intubation . Supraglottic airway(SGA) devices offer an alternative advanced airway management technique to endotracheal intubation (ETI) during OHCA. SGA devices may offer an advantage over ETI as they are simpler and faster to place. Additionally, proficiency with SGAs requires less training and ongoing practice. Although there have been several recent studies published on airway management in OHCA, this post/podcast will focus on the recently published AIRWAYS-2 trial. Read more →
REBEL Cast Ep58 – Would you be SHoC-ED if POCUS did not Improve Clinical Outcomes in Patients with Undifferentiated Shock?
Background: POCUS has been touted as the stethoscope 2.0, a true game changer in patient care. There is no patient population that this statement should hold more true for, than in patients with undifferentiated shock (SBP <100mmHg or SI > 1). Everyone has a story about how ultrasound changed their management or even saved a patient’s life. Unfortunately, the plural of anecdote is not data. To date, there have not been any prospective randomized controlled trials examining POCUS outcomes on survival in this population. Enter the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) trial. Read more →
Background: In the ED, POCUS has become one of the most important tools in discovering both the diagnosis and in the management of critically ill patients. cardiac arrest, is ultimately as sick as a person can get in the spectrum of critical illness. I mean how can someone be deader than dead, right? There has been a slew of literature evaluating the use of POCUS in cardiac arrest and many providers have started to incorporate its use into their practice. Newer literature, however indicates that the use of POCUS prolongs CPR pauses which ultimately impacts good neurological survival. POCUS protocols may help decrease cognitive load, but many are too cumbersome and complicated. Enter the Cardiac Arrest Sonographic Assessment (CASA) exam. Read more →