What should I do if my patient re-arrests into a shockable rhythm and my transport time is excessive?

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asked 2 years ago

If my patient re-arrests into a shockable rhythm and I did my one analysis but they remain in a shockable rhythm, or I departed the scene because they are in a refractory VF or Pulseless VT, should I stop every 2 minutes to analyze and shock? Continue transport with CPR only? Patching to the BHP could be challenging to do if we are alone in the back or out of cell range.

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answered 2 years ago

Thank you for the question regarding re-arrest with shockable rhythms.
In this situation, no one process would cover all situations. Things to consider would be patient age and comorbidities, availability of antiarrhythmic medications, potential for vector change of double sequential defibrillation, quality of CPR, distance to ED and I am sure a few other factors could play a role.
I would encourage you not to stop every two minutes as this would lead to very prolonged transport time. In the event of ongoing refractory VF or pulseless VT where you have decided to leave the scene and proceed to the ED, I would pre-plan 1 or 2 stops to perform a rhythm interpretation. These stops should be based on your distance to hospital and can occur at 10 or 15 minute intervals.
If the patient re-arrests after a ROSC, I would consider stopping and attempt defibrillation at least 3 times if the patient is in a shockable rhythm. If the patient is in a non-shockable rhythm, I would base my resuscitation efforts on proximity to the hospital (one analysis and go if close proximity, 3 analysis with medication delivery if not in close proximity).
Also don’t forget about vector change to the AP position if you have a patient with refractory shockable rhythm.