Refibrillation during out-of-hospital arrest: A frequent event with clinical consequences

The refibrillation was a frequent event in out-of-hospital cardiac arrest (OHCA). The number of recurrences of ventricular fibrillation (VF) is in inverse relationship with survival. In this article we discuss about causes and mechanism of refibrilla-tion. The amiodarone and new technical solution (defibrillators that may allow continuous monitoring of the heart rhythm, while chest compressions continue and recommend defibrillation when refibrillation occurs) are promising new strategy to improve outcome of OHCA and recurrent VF.

out-of-hospital cardiac arrest, ventricular fibrillation, defi-brillation, refibrillation, amiodarone, continuous monitoring of the heart rhythm

1. White RD, Russell JK. Refibrillation, resuscitation and survival in out-of-hospital sudden cardiac arrest victims treated with biphasic auto-mated external defibrillators. Resuscitation 2002;55:17-23.

2. Van Alem AP, Post J, Koster RW. VF recurrence: Characteristics and patient outcome in out-of-hospital cardiac arrest. Resuscitation 2003;59:181-8.

3. Hess EP, White RD. Ventricular fibrillation is not provoked by chest compression during post-shock organized rhythms in out-of-hospital cardiac arrest. Resuscitation 2005;66:7-11.

4. Osorio J, Dosdall DJ, Robichaux RP Jr, Tabereaux PB, Ideker RE. In a swine model, chest compressions cause ventricular capture and, by means of a long-short sequence, ventricular fibrillation. Circ Arrhythm Electrophysiol 2008;1:282-9.

5. Berdowski J, Tijssen JG, Koster RW. Chest compressions cause recurrence of ventricular fibrillation after the first successful conversion by defibrillation in out-of-hospital cardiac arrest. Circ Arrhythm Electrophysiol 2010;3:72-8.

6. Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med 2002;346:884-90.

7. Kudenchuk PJ, Cobb LA, Copass MK,Cummins RO, Doherty RO, Fahrenbruch CE, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med 1999;341:871-8.