Key result
Novel refractory VF bundle is linked to successful defibrillation and survival to discharge.
Why the study?
Cardiac arrest secondary to persistent ventricular fibrillation or ventricular tachycardia is challenging to manage in the prehospital setting, and specialised care bundles are not well described.
Case Report (n=1)
A paramedic-led refractory ventricular fibrillation bundle including mechanical CPR, vector change defibrillation, and esmolol was associated with successful termination of persistent VF and neurologically intact survival.
Answers are grounded in this paper and cite their sources.
May support refractory VF bundle use in select cases; hypothesis-generating case report leaves efficacy open for prospective trials.
Cardiac arrest secondary to persistent ventricular fibrillation or ventricular tachycardia (pVF/VT) is challenging to manage, particularly in the prehospital setting. This report, prepared in keeping with CARE guidelines, discusses a 70-year-old male who survived to discharge with pre-morbid neurological function after a prolonged cardiac arrest with pVF. Clinical interventions included mechanical CPR, vector change defibrillation, de-emphasised adrenaline and intravenous esmolol. We believe this may be the first reported case of a paramedic-led team providing this care bundle in the UK outside of a research setting. In this case a refractory pVF/VT bundle appeared to be associated with terminating pVF. This report may be of use to other pre-hospital services considering introducing specialised care bundles for this case type, as well as adding to the body of evidence for the complex pharmacological relationship between adrenergic agonists, antagonists and persistent shockable rhythms.
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Horne et al. (2025) conducted a case report in Out of hospital cardiac arrest secondary to persistent ventricular fibrillation or ventricular tachycardia (n=1). Refractory ventricular fibrillation bundle (mechanical CPR, vector change defibrillation, de-emphasised adrenaline, intravenous esmolol) was evaluated on Survival to discharge with pre-morbid neurological function and termination of persistent ventricular fibrillation. A refractory ventricular fibrillation bundle, including mechanical CPR, vector change defibrillation, and intravenous esmolol, was associated with terminating persistent VF and survival to discharge.
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