Dr. McGovern is an emergency medicine resident at St. Joseph’s Regional Medical Center in Paterson, New Jersey.
Explore This Issue
ACEP Now: Vol 34 – No 11 – November 2015
Dr. Justin McNamee is an attending physician at Emergency Medicine Professionals in Ormond Beach, Florida.
References
- Nademanee K, Taylor R, Bailey WE, et al. Treating electrical storm: sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation. 2000:102(7);742-747.
- Eifling M, Razavi M, Massumi A. The evaluation and management of electrical storm. Tex Heart Inst J. 2011:32(8);111-121.
- Driver BE, Debaty G, Plummer DW, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation. Resuscitation. 2014:85(10);1337-1341.
- Miwa Y, Ikeda T, Mera H, et al. Effects of landiolol, an ultra-short-acting ß1-selective blocker, on electrical storm refractory to class III antidysrhythmic drugs. Circ J. 2010:74(5);856-863.
- Hoch DH, Batsford WP, Greenberg SM, et al. Double sequential external shocks for refractory ventricular fibrillation. J Am Coll Cardiol. 1994:2;1141-1145.
- Cabañas JG, Myers JB, Williams JG, et al. Double sequential external defibrillation in out-of-hospital refractory ventricular fibrillation: a report of ten cases. Prehosp Emerg Care. 2015:19(1);126-130.
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3 Responses to “Emergency Interventions for Treating Cardiac Electrical Storms”
January 13, 2016
Steven SawyerI read this article this past weekend and knew that even though I had never seen a case of refractory Vfib I knew I would shortly. So I was not actually surprised when the 45 year old man brought in cardiac arrest had Vfib for which he had received two doses of epi and three shocks by ems. An LMA was in place and while cpr continued I had to wait to see the monitor. During a change in compression hands I saw the fine vfib and delivered another defib with epi and amiodarone to no avail. During the next cycle I had a chance to brief the team on the article I had read and get a copy so we could check the dose of Esmolol while maxing the amiodarone and applying the 5th shock. However, it turned out that we had no Esmolol in the ED. At this point it was 30 since being found down. I set the two defibrillators and performed the double sequential external defibrillation which initially converted from fine vfib to asystole After additional CPR and an additional attempt the code was called. It turned out that the pt had initially been over come with carbon monoxide which lead directly to his cardiac dysrhythmia. Had I known this I may have elected to remove the LMA and intubate for better oxygen support. But overall my team was fast and compliant with the strange instructions I gave. It just didn’t work this time.
March 7, 2017
günther krumpl0–100 mcg/kg/hr (0–0.1 mg/kg/hr)
Please correct the text in the publication to the right dose which should be
0-100 mcg/kg/min.
In addition I want to mention that 0 in 0-100 makes no sense, the starting dose of esmolol is 50. So it should say 50-100 …
April 14, 2017
Dawn Antoline-WangThank you, the article has been updated to indicate mcg/kg/min instead of mcg/kg/hr.