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Postdefibrillation idioventricular rhythm--a salvageable condition.

J R Hoffman, L W Stevenson

    The Western Journal of Medicine
    |February 1, 1987
    PubMed
    Summary
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    Pulseless idioventricular rhythm after defibrillation for ventricular fibrillation may indicate transient recovery, not a poor prognosis. A brief trial of CPR without immediate drugs may be suitable for these patients.

    Area of Science:

    • Emergency Medicine
    • Cardiology
    • Critical Care

    Background:

    • Pulseless idioventricular rhythm (IVR) typically carries a poor prognosis.
    • The clinical significance of IVR following defibrillation for ventricular fibrillation (VF) is not well-defined.

    Purpose of the Study:

    • To investigate the clinical significance and patient outcomes associated with pulseless IVR after defibrillation for prehospital VF.
    • To determine the optimal management strategy for this specific rhythm.

    Main Methods:

    • Retrospective review of 100 consecutive patients with prehospital VF.
    • Analysis of outcomes (survival to admission, discharge) based on post-defibrillation rhythm: pulseless IVR, other organized rhythms, or no organized rhythm.
    • Comparison of outcomes between patients receiving advanced cardiac life support (ACLS) drug therapy versus those receiving only cardiopulmonary resuscitation (CPR).

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    Main Results:

    • Patients defibrillated into pulseless IVR had worse outcomes than those defibrillated into other organized rhythms (P<.05).
    • However, outcomes for pulseless IVR patients were significantly better than for those who achieved no organized rhythm (P<.05).
    • No significant difference in outcomes was observed between patients treated with ACLS drugs for pulseless IVR versus those who spontaneously converted before drug administration.

    Conclusions:

    • Pulseless IVR following defibrillation for VF may represent a transient recovery rhythm.
    • This rhythm can be associated with a reasonable outcome in certain patients.
    • A short trial of CPR alone, without immediate drug intervention, may be an appropriate initial management strategy.