Monday, August 19, 2013

 Q: Which drug works best for Ventricular fibrillation resulting from hypothermia?

Answer: Bretylium

Ventricular fibrillation in a hypothermic patient is a very frustrating and desperate event. Defibrillation is usually ineffective. Recommendation is to attempt a round of chemical conversion with intravenous bretylium accompanied by CPR until active rewarming can be done to perform successful defibrillation.

  1. Murphy K, Nowak RM, Tomlanovich MC. Use of bretylium tosylate as prophylaxis and treatment in hypothermic ventricular fibrillation in the canine model. Ann Emerg Med. Oct 1986;15(10):1160-6.
  2. Vachiery JL, Reuse C, Blecic S, Contempre B, Vincent JL. Bretylium tosylate versus lidocaine in experimental cardiac arrest. Am J Emerg Med. Nov 1990;8(6):492-5
  3. Buckley JJ, Bosch OK, Bacaner MB. Prevention of ventricular fibrillation during hypothermia with bretylium tosylate. Anesth Analg. Jul-Aug 1971;50(4):587-93

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