The Treatment of Refractory Ventricular Fibrillation: What Works, What Doesn’t, and What’s Next

Abstract

Background: Cardiac arrest is a sudden heart condition that can cause ventricular fibrillation (VF). The current standard for the treatment of VF is defibrillation. After multiple defibrillations without a change in rhythm, the VF is refractory and called refractory ventricular fibrillation (RVF). This study reviews novel treatments for RVF and compares them to traditional Advanced Cardiac Life Support (ACLS) treatments. Objectives: This review aims to summarize novel treatments for RVF and identify which treatments would benefit neurological and hospital discharge outcomes. Methods: Literature pertaining to RVF and treatments that included double sequential defibrillation (DSD), esmolol, and extracorporeal cardiopulmonary resuscitation (eCPR) were reviewed. Different clinical study designs were utilized, such as observational case studies and randomized controlled trials. Findings: Multiple studies on DSD and esmolol provided different information, but some indicated that outcomes proved superior to traditional methods. eCPR studies indicated that RVF treatments with eCPR had vastly superior outcomes to conventional methods. Conclusions: DSD and esmolol studies had conflicting findings, and more studies need to be done in a randomized controlled trial to prove the efficacy of DSD and esmolol. However, the usage of DSD and esmolol should be considered in patients with RVF if the standard of care is not working and if resources do not allow for eCPR to be performed. eCPR’s randomized controlled trials proved superior in RVF outcomes and should be utilized as a standard in cardiac arrest algorithms if resources are available.