19/04/2021
#3. :) No need to run off.
How about this amazing study for a post!
A 3-month old out of hospital cardiac arrest occurred in UK, with a presenting rhythm of V-Fib. A total of 10 defibrillations were performed over a 25 minute cardiac arrest using and AED with adult pads. ROSC was finally achieved on scene (they didn't rush off scene 👍).
What are the notable aspects of this case?
1. The patient had recurrent VF as the presenting rhythm(typically less than 10% of all infant arrests) and received 10 appropriate AED shocks.
2. The AED effectively terminated the rhythm yet it continued to recur. This is not 'refractory' Vfib, instead it's recurrent Vfib, meaning that dual sequential defibrillation (DSED) would not have worked here.
3. The stay on scene strategy was life-saving.
4. ROSC occurred 7 minutes after the last epi possibly implying that clearing it from the system actually helped establish a perfusing rhythm (i.e. Epi may be harmful in VF).
5. The early resumption of compressions without rhythm analysis was associated with re-fibrillation from an organized rhythm showing that we do miss ROSC sometimes and likely reinduce VF even as we monitor EtC02 and look for other signs of native perfusion.
Great job by our colleagues at London Ambulance Service NHS Trust, Stryker, and the study authors for this great case study!
Read the full case report here: http://ow.ly/bVVc30rEEIG