A 62-year old male is admitted through the Emergency Department (ED) with a fifty-hour history of worsening sore throat, cough, and increased work of breathing.
Does lidocaine or amiodarone make it more likely to successfully defibrillate a patient experiencing refractory ventricular fibrillation?
ANSWER: Extensive peer-reviewed data exists regarding this question. Patients receiving lidocaine or amiodarone to treat refractory ventricular fibrillation (VF) have demonstrated no improvement in response to defibrillation or survival.
Troubling information exists regarding the negative effect of these anti-arrhythmic drugs on the defibrillation threshold. Some practitioners specifically avoid these agents unless the VF responds to electrical therapy but reoccurs. In recurrent VF, the evidence seems to demonstrate these agents have the potential to reduce repeated reinduction.
Some believe that as long as CPR (chest compressions and ventilation) continues, the patient will likely survive.
ANSWER: For the last 4 decades, the literature is replete with studies showing that CPR provides outcome and survival benefits in patients awaiting definitive treatment for their arrest.
Except for situations such as hypothermia, patients receiving CPR for more than 10 minutes have virtually no survival. This is why rapid identification and treatment of the cause(s) of refractory arrest provides the greatest possibility of overall survival.
Does CPR/ACLS treatment need to be initiated in all patients having sudden cardiac arrest?
ANSWER: There are many situations in which initiating resuscitation would be improper.
The most obvious is medical futility. Once it is known that the underlying cause of arrest is untreatable, attempts to resuscitate become interventions that are not in the patient’s best interest. Other situations such as legally appointed agents (durable power of attorney for health care) preventing such care are legally and medically proper.
However, many times, all of the facts needed for proper medical decision-making are not available, making the initiation of resuscitative care proper until information becomes available. Prospective decision-making through a DNR prescription can help prevent unnecessary care in many situations.