Why the study?
VT storm is associated with significant mortality and requires emergent stabilization to avoid escalation to intubation, sedation, and intensive care admission prior to transfer for definitive management.
Amiodarone and lidocaine infusions can successfully stabilize patients with VT storm in the emergency department, avoiding the need for intubation and central sympathetic blockade prior to definitive AICD placement.
Early ED stabilization feasible in VT storm; hypothesis-generating for pre-ICD protocols, needs prospective validation.
This report describes a case of ventricular tachycardia (VT) storm managed in the emergency department prior to transfer for automatic implantable cardioverter-defibrillator (AICD) placement.VT storm is associated with significant in-hospital and 6-month mortality, necessitating emergent stabilization and definitive secondary prevention.While ACLS and antiarrhythmic drugs (AAD) are the mainstays of emergency management, early referral is indicated for ICD placement, catheter ablation, and/or sympathetic cardiac denervation.In the setting of sustained or recurrent VT (including VT storm), amiodarone and/or lidocaine can be administered not only as boluses but also as infusions.This strategy can stabilize the patient for transfer (if needed) and avoid escalation to intubation and sedation for central sympathetic blockade, which would necessitate admission to intensive care.
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Antony Awad (2023) studied this question.
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