Emergency simultaneous transthoracic and epicardial defibrillation for refractory ventricular fibrillation during routine implantable cardioverter-defibrillator testing in the operating room

Innovative emergency defibrillation methods for refractory ventricular fibrillation in a variety of hospital settings

This article reviews the ability of innovative rescue defibrillation techniques for the treatment of refractory ventricular fibrillation. These data were obtained in a variety of hospital settings at the University of California, San Francisco, from 1986 to 1992. Innovative rescue defibrillation techniques were applied to 15 patients with refractory ventricular fibrillation having failed > or = 2 high-energy transthoracic shocks in a variety of hospital settings. Intracardiac defibrillation was performed from a right ventricular catheter to a posterior patch in nine patients who had refractory ventricular fibrillation in the course of invasive electrophysiologic testing. Emergency simultaneous transthoracic and epicardial defibrillation was successfully performed with standard paddles placed over the thorax in contact with epicardial patch or pacing lead connectors in two patients in the operating room who underwent implantable cardioverter-defibrillator insertion and failed standard rescue defibrillations. Transesophageal defibrillation was performed in four patients in the emergency department who had a refractory ventricular fibrillation in the field. Intracardiac defibrillation successfully terminated refractory ventricular fibrillation in 9 of 9 patients in the electrophysiology laboratory. Similarly, emergency simultaneous transthoracic and epicardial defibrillation restored sinus rhythm in two patients in the operating room. Transesophageal defibrillation performed after 50 minutes of cardiac arrest successfully terminated ventricular fibrillation in each patient. Thus alternative methods now exist that permit rescue defibrillation in a variety of hospital emergency settings. These techniques are performed with simple-to-use equipment that is compatible with standard defibrillators.