Refractory VF

As we all know, rapid and effective resuscitation makes a huge difference to the chance of survival from a cardiac arrest.

If you’re going to pick a rhythm to have as the patient or as the Resuscitationist, then it’s going to be a shockable rhythm, so VF or pulseless VT as they hold the greatest chance of survival. You’ll find an initial shockable rhythm in around 20% of cases & defibrillation alone may lead to a ROSC. So it’s absolutely imperative to get the immediate management spot on!

Whilst current practice is good, there are some aspects of care that we can improve on and make a real difference to outcomes in these patients, with those first on scene or at the bedside in a phenomenally important position to deliver life saving care.

In this episode we’ll be talking predominantly about refractory VF but the strategy will transfer to how we can also deal with refractory VT cardiac arrests. 

We’ll be running through all of the following;

  • VF incidence
  • Mechanisms behind VF
  • Refractory and recurrent VF
  • Defibrillation strategies
  • Pharmacological strategies
  • PCI in arrest
  • ECMO

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

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Abstract 419: Incidence of True Refractory Ventricular Fibrillation in Patients Meeting a Pragmatic Definition of Refractory Ventricular Fibrillation. Verkaik. Criculation. 2023

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Intra-arrest percutaneous coronary intervention: a case series. Balevski. Wein Kin Wochenschr. 2015 

Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. Sovereign. NEJM. 2023

Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. Belohlavek. JAMA. 2022

Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Yannopolous. Lancet. 2020

Early extracorporeal CPR for refractory out-of-hospital cardiac arrest – A pre-planned per-protocol analysis of the INCEPTION-trial. Ubben. Resuscitation. 2023

Supraglottic airway devices are associated with asphyxial physiology after prolonged CPR in patients with refractory Out-of-Hospital cardiac arrest presenting for extracorporeal cardiopulmonary resuscitation. Bartos. Resuscitation. 2023

A randomized trial of expedited intra-arrest transfer versus more extended on-scene resuscitation for refractory out of hospital cardiac arrest: Rationale and design of the EVIDENCE trial. Burns. Am Heart J. 2024

LITFL; Ventricular Fibrillation

Mononmorphic VT Storm; IBCC

Course Content

1 Comment

  • tony.king1 says:

    Excellent Podcast as normal.
    enlightening and reinforcing the benefits of vector change and DSD in refractory and recurrent VF

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