Utilising a refractory ventricular fibrillation bundle to improve outcome in out of hospital cardiac arrest: A case report

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.