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Cardioversion protocol for ventricular fibrillation: a more differentiated approach

Leiden University Medical Center, Department of Cardio-thoracic Surgery, Albinusdreef 2, 2333 AC Leiden, Netherlands

What cardioversion protocol for ventricular fibrillation should be followed for patients who arrest shortly post-cardiac surgery?

Without any doubt, the authors are right in their statement that more than three shocks are hardly effective in patients with ventricular fibrillation shortly after cardiac surgery [1]. However, I am not quite sure that this is the case when external cardiac massage (by hand and not by machines) is effective (patients on the Intensive Care Unit will mostly have an arterial pressure monitoring) and concomittant with the shocks a single dose of Amiodarone is applied.

In the Netherlands, and I suppose this is the case in other European countries, it is no longer common practice to have residents of the Cardiothoracic surgery department in the hospital during the night. Due to the regulations on working hours, the number of residents needed for around the clock service is huge. Because of this, it can take 10 to 15 min before somebody capable of reopening the chest has arrived at the Intensive Care Unit. In our case, we experienced some good results from a fourth or even fifth shock, Amiodarone and of course, effective cardiac massage.

I advise to add to the recommendation: While waiting for somebody capable of reopening the chest, external cardiac massage should be continued and after a single dose of 5 mg/kg body weight of Amiodarone, two more shocks can be tried.

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1. Richardson L, Dunning J, Dissanayake A. What cardioversion protocol for ventricular fibrillation should be followed for patients who arrest shortly post cardiac surgery? Interact CardioVasc Thorac Surg 2007; 6:799–805.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Versteegh, M. I. Search for Related Content PubMed PubMed Citation Articles by Versteegh, M. I. Related Collections Related Article