Evaluation of Esmolol and/or Double Sequential External Defibrillation (DSED) for Refractory Ventricular Fibrillation (RVF)

Document Type

Conference Proceeding

Publication Date

1-8-2025

Publication Title

Am J Health Syst Pharm

Abstract

Purpose: Refractory ventricular fibrillation (RVF) is a severe condition often observed in out-of- hospital cardiac arrests, with survival rates ranging from 8% to 15%. This contrasts with the 29% survival rate seen in ventricular fibrillation or pulseless ventricular tachycardia, highlighting RVF as a rare yet life-threatening emergency. Although the current American Heart Association (AHA) guidelines for ACLS in adults do not mention the use of esmolol and recommend against the use of DSED, recent studies indicate potential benefits of these interventions. This study aims to assess outcomes associated with esmolol and/or DSED in patients with RVF in the emergency department (ED). Methods: The IRB application for this project was submitted and is currently waiting for approval. This is a retrospective cohort study of RVF patients who receive esmolol and/or DSED at a level one trauma ED treating nearly 100,000 patients annually. The primary outcome is incidence of sustained return of spontaneous circulation (ROSC) which is defined as at least 20 minutes without recurrence of cardiac arrest. Secondary outcomes include 24-hour survival, survival to intensive care unit, and survival to hospital discharge. Clinical data including medications used during cardiac arrest, vasopressor use, use of respiratory support, emergency department disposition, and hospital disposition will be collected. Patients will be included if they were at least 18 years of age and received esmolol and/or DSED for RVF in the ED between August 1st, 2020, to September 1st, 2024. The definition of RVF will be failure to achieve ROSC despite three consecutive defibrillation attempts, administering 300 mg of amiodarone or 1-1.5 mg/kg of lidocaine, and 3 mg of epinephrine. Vulnerable populations including children, pregnant women, incarcerated patients, and or cognitively impaired will be excluded. Due to the rare incidence of our patient population, we will include up to 50 patients or four years of patient data, whichever comes first. Data will be analyzed using measures of central tendency with mean with standard deviation or median with interquartile range, where appropriate.

Volume

82

Issue

Supplement_1

First Page

S818

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