Comparison of nifekalant and amiodarone for resuscitation of out-of-hospital cardiopulmonary arrest resulting from shock-resistant ventricular fibrillation

BackgroundOut-of-hospital cardiopulmonary arrest (OHA) is an international health issue. There is an urgent need to better understand the key factors that affect OHA survival. Epidemiological surveillance is the first step towards scientific understanding of the problem. This study looks at the profiles of patients who suffered an OHA.MethodologyIn this retrospective study, the medical records of all patients who died upon arrival at Tan Tock Seng Hospital, Emergency Department (TTSH ED) between 1st January 2009 and 31st December 2009 were reviewed. The outcomes include patient demographics, pre-hospital management and the cause of death.ResultsWithin the study period, there were a total of 275 OHA, 5 (1.8%) traumatic and 270 (98.2%) non-traumatic cases. Emergency Medical Service (EMS) conveyed 247 (91.5%) of OHA and 23 (8.5%) arrived by self-transport. The incidence of non-traumatic OHA was 14 per 10,000 ED attendees, predominantly male (72.2%). Male were significantly younger than female (63 vs 70 years, p = 0.002). The commonest initial cardiac arrhythmia recorded on scene by paramedics was asystole (54.1%), pulseless electrical activity (34.8%) and ventricular fibrillation (11.1%). One hundred sixty-one (59.6%) patients collapsed during the day (0600 – 1759 hours). Patients found in ventricular fibrillation on scene peaked in the morning (1020hours). All OHA were started on cardiopulmonary resuscitation, intubated with laryngeal airway mask, given intravenous adrenaline, and all ventricular fibrillation was electrically defibrillated en-route by the paramedics. Despite continued resuscitative efforts in the ED, all remained in asystole. The State Coroner reviewed 266 (96.7%) OHAs, of which, 96 (36%) were subjected to post mortem. Among patients with asystole at scene, acute coronary syndrome (55.2%), hypertensive heart disease (13%) and bronchopneumonia (5.2%) were the three commonest cause of death. The commonest cause of death for ventricular fibrillation at scene was acute coronary syndrome (76.7%), of which 10 (43.5%) had no pre-existing medical conditions.ConclusionIn our study population, majority of patients had asystole as their presenting arrhythmia at scene. OHA with ventricular fibrillation demonstrated significant circadian differences and the underlying cause of death was acute coronary syndrome. This knowledge will allow EMS to devise future strategies that have the greatest potential to improve survival outcomes.

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Ventricular Fibrillation Cardiopulmonary Arrest Following Micra™ Leadless Pacemaker Implantation

Journal of Innovations in Cardiac Rhythm Management ◽

10.19102/icrm.2021.121102 ◽

2021 ◽

Vol 12 (11) ◽

pp. 4756-4760

Author(s):

HUZAIFA AHMAD ◽

VIJAYWANT BRAR ◽

NAUSHARWAN BUTT ◽

VISHAKA CHETRAM ◽

SETH WORLEY ◽

...

Keyword(s):

Ventricular Fibrillation ◽

Cardiopulmonary Arrest ◽

Pacemaker Implantation ◽

Leadless Pacemaker

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A focused investigation of expedited, stack of three shocks versus chest compressions first followed by single shocks for monitored ventricular fibrillation/ventricular tachycardia cardiopulmonary arrest in an in-hospital setting

Journal of Hospital Medicine ◽

10.1002/jhm.2499 ◽

2015 ◽

Vol 11 (4) ◽

pp. 264-268 ◽

Cited By ~ 3

Author(s):

Daniel Davis ◽

Steve A. Aguilar ◽

Rebecca Sell ◽

Anush Minokadeh ◽

Ruchika Husa

Keyword(s):

Ventricular Tachycardia ◽

Ventricular Fibrillation ◽

Cardiopulmonary Arrest ◽

Hospital Setting ◽

Chest Compressions

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THE ELECTROCARDIOGRAPHIC FEATURE OF ACUTE MYOCARDIAL INFARCTION COMPLICATED BY VENTRICULAR FIBRILLATION SURVIVING FROM OUT-OF-HOSPITAL CARDIOPULMONARY ARREST

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)31040-4 ◽

2018 ◽

Vol 71 (11) ◽

pp. A499

Author(s):

Koji Sudo ◽

Yukio Hosaka ◽

Kazuyoshi Takahashi ◽

Takumi Akiyama ◽

Takahiro Hakamata ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ventricular Fibrillation ◽

Cardiopulmonary Arrest

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Esmolol for the treatment of refractory ventricular fibrillation: a systematic review and meta-analysis

Irish Journal of Paramedicine ◽

10.32378/ijp.v4i2.177 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Richard Armour ◽

Leon Baranowski

Keyword(s):

Systematic Review ◽

Ventricular Fibrillation ◽

Hospital Admission ◽

Hospital Discharge ◽

Life Support ◽

Cardiopulmonary Arrest ◽

Meta Analysis ◽

Grey Literature ◽

Neurological Status ◽

Cochrane Library

Introduction: In light of recent research the efficacy of current advanced life support treatments has been questioned. Ventricular fibrillation refractory to standard therapy is a presentation which may benefit from an updated approach to management, with the b1-adrenoreceptor antagonist esmolol considered a therapy which may confer benefit. This systematic review and meta-analysis aimed to summarise the available evidence for esmolol in refractory ventricular fibrillation and identify if it may have any role in ACLS guidelines.Methods: The Cochrane Library, MEDLINE, CINAHL and EMBASE were systematically reviewed, along with trial registries and the grey literature. Studies were included in the review and subsequent meta-analysis if they examined adult patients in cardiopulmonary arrest with ventricular fibrillation refractory to at least three attempts at defibrillation and one dose of adrenaline or anti-arrhythmic therapy, who subsequently received intravenous esmolol.Results: 2,617 results were obtained with 12 full-text articles reviewed for inclusion. Ultimately, two unique results fulfilled the inclusion criteria. A total of 66 patients were included in the meta-analysis, of whom 22 received esmolol. Esmolol appears to improve to survival to hospital admission (RR 2.63, 95% CI 1.37-5.07, p=0.004), temporary (RR 2.34, 95% CI 1.09-5.02, p=0.03) and sustained ROSC (RR 2.63, 95% CI 1.37-5.07, p=0.004) and favourable neurological status at hospital discharge (RR 3.44, 95% CI 1.11-10.67, p=0.03). The use of esmolol also appeared to likely confer a benefit in survival to hospital discharge (RR 2.82, 95% CI 1.01-7.93, p=0.05). However, significant bias was observed across all outcomes and overall these results were considered to be of low to very low certainty.Conclusion: The use of esmolol in refractory ventricular fibrillation appears to improve survival to hospital admission, temporary and sustained ROSC and neurological status at hospital discharge, but not survival to hospital discharge. However, these results should be interpreted with caution in light of the limitations of included studies and the subsequent impact of these limitations on the outcomes included in the meta-analysis. Further high-quality, prospective research is required prior to recommending esmolol for use in refractory ventricular fibrillation.

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Ventricular Fibrillation Cardiopulmonary Arrest Following Micra Leadless Pacemaker Implantation

10.22541/au.160691426.63340870/v1 ◽

2020 ◽

Author(s):

Nausharwan Butt ◽

Huzaifa Ahmad ◽

Vijaywant Brar ◽

Vishaka Chetram ◽

Arooge Towheed ◽

...

Keyword(s):

Ventricular Fibrillation ◽

Cardiac Tamponade ◽

Ventricular Arrhythmias ◽

Cardiopulmonary Arrest ◽

Pacemaker Implantation ◽

Cardiac Pacemakers ◽

Leadless Pacemaker ◽

Leadless Pacing

Leadless cardiac pacemakers such as the Micra transcatheter leadless pacing system provide an alternative to traditional transvenous pacemakers. Implantation of leadless pacemakers, albeit safe may be associated with complications including cardiac tamponade, high capture thresholds, and rarely, ventricular arrhythmias. We report a case of ventricular fibrillation arrest following Micra leadless pacemaker implantation.

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Comparison of nifekalant and amiodarone for resuscitation after cardiopulmonary arrest due to shock-resistant ventricular fibrillation

Critical Care ◽

10.1186/cc9711 ◽

2011 ◽

Vol 15 (S1) ◽

Author(s):

N Harayama ◽

S Nihei ◽

Y Isa ◽

H Arai ◽

T Shinjou ◽

...

Keyword(s):

Ventricular Fibrillation ◽

Cardiopulmonary Arrest

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An unusual case report of stress-induced cardiomyopathy presenting as ventricular fibrillation cardiopulmonary arrest and third-degree atrioventricular block

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab142 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Akarsh Parekh ◽

Vivek Sengupta ◽

Mark Zainea

Keyword(s):

Ventricular Fibrillation ◽

Ejection Fraction ◽

Takotsubo Cardiomyopathy ◽

Plaque Rupture ◽

Cardiopulmonary Arrest ◽

Case Reports ◽

Apical Ballooning ◽

Av Block ◽

Rare Presentation ◽

Coronary Syndrome

Abstract Background Takotsubo cardiomyopathy (TCM) can clinically present as an acute coronary syndrome; however, the former has regional wall motion abnormalities that extend beyond a single coronary vascular territory without any plaque rupture. Takotsubo cardiomyopathy classically involves apical ballooning of left ventricle (LV). It is uncommon for TCM to present as cardiopulmonary arrest (CPA) along with third-degree atrioventricular (AV) block. Case summary A 63-year-old female, underwent a ventricular fibrillation (VF) CPA. She was defibrillated three times and return of spontaneous circulation (ROSC) was achieved after 37 min. Her post-ROSC electrocardiogram showed non-specific ST-segment changes and T-wave inversions and soon progressed to third-degree AV block. Patient had a transvenous pacemaker placed to pace her heart. Echocardiogram showed an LV ejection fraction of 15–20% with akinesis of the apex and anteroseptum. An echocardiogram repeated 4 days after the cardiopulmonary arrests showed an ejection fraction of 60–65% with hypokinesis of mid anterior and antero-apical hypokinesis. However, the patient still continued to require a pacemaker and hence eventually received a dual-chamber pacemaker/implantable cardioverter-defibrillator for her AV block and ventricular arrhythmia. Discussion Most commonly TCM presents with chest pain and symptoms of acute myocardial infarction. We present a very rare presentation of TCM associated with VF and CPA along with third-degree AV block. There have handful of case reports documenting TCM causing CPA in some patients and other case reports showing TCM causing high degree AV block. In our patient, TCM was associated with both VF and CPA along with third-degree AV block.

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