ventricular fibrillation

To this end, they published a retrospective analysis in the journal Chest.

The study analyzed over six hundred adults with refractory VFib or pulseless VTach who received lidocaine or amiodarone, drawn from forty hospitals in China.

The primary outcome was survival to hospital discharge or thirty days.

Secondary outcomes included sustained return of spontaneous circulation and favorable neurologic outcome at discharge or thirty days.

After applying multivariable adjustment, there were still no significant differences observed for survival or any outcomes.

This finding persisted even when exploratory subgroup analysis was performed.

The authors concluded, "To our knowledge, this is the first study to compare lidocaine and amiodarone, specifically in a rigorously adjudicated cohort of adult refractory VFib/pulseless VTach in-hospital cardiac arrest patients from a national multi-center prospective registry.

We observed no significant differences in outcomes between the two agents, providing real-world evidence that supports guideline recommendations allowing either antiarrhythmic drug during resuscitation." In my experience, clinicians have their preferred antiarrhythmic to use during in-hospital cardiac arrests, and they never change which one they use first.

I don't think they mean they plural, but it's just unclear whether it's Sidwell or Curtis that they are talking about.

And with Sidwell in V-Fib, he seems the most obvious as the one who might die, but there are red flags for Curtis too.

I'm seeing signs that make me look like, make me think that there's a chance Curtis won't survive the brutal beating.

He's got broken ribs and bruises and lacerations.

You have to understand how to treat certain cardiac rhythms.

Somebody who's an AFib, VFib, VTAC, you have to know, okay, there's drugs that if you don't address this, their heart's going to stop or they're going to, they're going to die in front of you.

I mean, I've had a number of people die, get there.

I mean, they've been in that state for 5, 10, 15 minutes, and it's like they're circling drain, and you get there.

I mean, you had to call for orders to start an IV.

You had to call for orders to shock someone in VFib.

I mean, you had to call for everything.

But now we have evolved to the point where paramedicine is no longer a – Being on an ambulance is not a transport benefit alone.

Fully expected to, yes.

But what about the absolute worst case, post-op VF or arrest?

You follow ACLS, but, and this is huge, you have to know the cardiac surgery protocol.

Right, limited shocks and compressions.

A stands for H, and the points increase significantly over 60 and over 80 years old.

C stands for change in rhythm, as in VF to PEA.

L stands for low pH, less than 7.2. And E stands for doses of epinephrine administered.

Each point is an unfavorable outcome, and a score of greater than 5 indicates a high risk of poor neurological recovery.

A stands for age, and the points increase significantly over sixty and over eighty years old.

C stands for change in rhythm, as in VF to PEA.

L stands for low pH, less than seven point two, and E stands for doses of epinephrine administered.

Each point is a unfavorable outcome, and a score of greater than five indicates a high risk of poor neurological recovery, which may lead a heart team to favor stabilization over immediate emergency angiography.

It's basically a really high functional system around the Twin Cities that they were taking these patients.

Their inclusion criteria was anyone from 18 to 75 years old with witnessed out-of-hospital cardiac arrest and refractory V-fib or V-tach with no ROSC after three shocks.

And they were included if their estimated transport time was less than 30 minutes.

The majority of these patients from the time they went down to the time they were on pump was 59 minutes, right around 60 minutes.

So every one of these patients was treated extremely aggressively.

getting their left heart cath.

Now, the important part about the inclusion criteria of V-fib and pulseless V-tach is that those are rhythms that are typically more associated with myocardial infarction and coronary artery disease.

So the majority of these patients did have a culprit lesion found on their left heart cath and they were immediately intervened upon.

And some accessory pathways are capable of extremely high heart rates.

So then your heart rate goes to 350, you go into VFib and you die probably.

Yeah, that's why it's good to go back to that point that we should figure out the rhythm.

And that's why you think about these key features.