Recurrent ventricular fibrillation during advanced life support care of patients with prehospital cardiac arrest

SummaryAim of the studyThe response of recurrent episodes of ventricular fibrillation (VF) to defibrillation shocks has not been systematically studied. We analyzed outcomes from countershocks delivered for VF during advanced life support (ALS) care of patients with out-of-hospital cardiac arrest.MethodsCohort of patients with prehospital cardiac arrest presenting with VF, treated by ALS ambulance staff following ERC Guidelines 2000. Biphasic defibrillators provided shocks increasing from 200 to 360 J. Recorded signals were analyzed to determine, for each shock, if VF was terminated and if a sustained organized rhythm was restored within 60 s.ResultsIn 465 of the 467 patients enrolled, the initial VF episode was terminated within three shocks: 92%, 61%, and 83% responded to 200 J first, 200 J second and 360 J third shocks, respectively. VF recurred in 48% of patients within 2 min of the first episode, and in 74% sometime during prehospital care. In the 175 patients experiencing five or more VF episodes, single shock VF termination dropped from the first to the fifth episode (90–80%, p < 0.001) without change in transthoracic impedance, yet the proportion returning to organized rhythms increased (11–42%, p < 0.0001).ConclusionsRepeated refibrillation is common in patients with VF cardiac arrest. The likelihood of countershocks to terminate VF declines for repeated episodes of VF, yet shocks that terminate these episodes result increasingly in a sustained organized rhythm.