A case of refractory ventricular fibrillation was simulated, outlining the challenges faced in a non-cardiac centre in a patient for whom standard Advanced Cardiac Life Support measures fail to achieve return of spontaneous circulation.
The simulation highlighted some excellent approaches worth sharing:
1. Having the nurse team leader ‘run the code’, ie. manage the cardiac arrest algorithm, was a highly effective way of allocating roles. This (a) ensured accurate timings, safe defibrillation, and effective task delegation (eg. drug preparation), and (b) freed the physician team leader’s cognitive capacity to focus on diagnosis, prognosis, effective management of the underlying cause, and steps ‘beyond the algorithm’.
2. Including paramedics in the sim enabled the scenario to be run from the point prior to handover, enabling simulation of the Batphone call as well as the logistics of moving the patient from ambulance stretcher to bed.
Here are some references related to the interventions tried and the concepts discussed in the debrief:
Terminology: No flow / low flow vs ‘down time’ – http://resus.me/down-with-down-time/
Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, et al.
Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital: A Consensus Statement From the American Heart Association. Circulation. 2013 Jul 22;128(4):417–35
Art lines & titrated adrenaline: EMCrit Podcast 130 – Hemodynamic-Directed Dosing of Epinephrine for Cardiac Arrest
Refractory VF: http://lifeinthefastlane.com/ccc/electrical-storm/ and http://www.emdocs.net/refractory-ventricular-tachycardia-approach-to-management/
Beaches Emergency Team 