Treatment of Pulseless Ventricular Tachycardia (VT)

Introduction

Pulseless ventricular tachycardia (VT) is a life-threatening arrhythmia that requires immediate intervention. It falls under the category of cardiac arrest rhythms and is treated similarly to ventricular fibrillation (VF).

Causes and Risk Factors

VT often occurs in patients with structural heart diseases such as: - Coronary artery disease (CAD) - Previous myocardial infarction (heart attack) - Heart failure - Electrolyte imbalances (e.g., low potassium or magnesium) - Drug toxicity (e.g., antiarrhythmics, tricyclic antidepressants)

Emergency Treatment Approach

1. Immediate Cardiopulmonary Resuscitation (CPR)

   • Start high-quality chest compressions immediately.
   • Provide rescue breaths at a 30:2 ratio (if trained in CPR).

2. Defibrillation (Electrical Shock)

   • Use a defibrillator as soon as it's available.
   • Deliver a shock with a biphasic defibrillator (120-200 J) or monophasic defibrillator (360 J).
   • Resume CPR immediately after defibrillation.

3. Advanced Life Support (ALS) Measures

   • Establish airway control using bag-mask ventilation or advanced airway devices.
   • Administer epinephrine (1 mg IV every 3-5 minutes).
   • Consider antiarrhythmic medications (e.g., amiodarone 300 mg IV, followed by 150 mg if needed).

4. Identifying the Underlying Cause

   • Check for reversible causes using the "Hs and Ts" approach:
     • Hypoxia, Hypovolemia, Hypo/Hyperkalemia, Hydrogen ion (acidosis), Hypothermia
     • Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (coronary or pulmonary)

5. Post-Resuscitation Care

   • If the patient regains circulation, initiate targeted temperature management (TTM) to improve neurological outcomes.
   • Evaluate the need for an implantable cardioverter-defibrillator (ICD).

Conclusion

Pulseless VT is a medical emergency that requires immediate action. Prompt defibrillation and effective CPR are key to patient survival. Understanding the underlying causes is crucial for preventing recurrence.

Source recommendations

1. American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

1. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines
2. https://professional.heart.org/en/science-news/2020-aha-guidelines-for-cpr-and-ecc
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001194
4. https://pubmed.ncbi.nlm.nih.gov/33081530/
5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000918

2. European Resuscitation Council Guidelines for Resuscitation

1. https://cprguidelines.eu/guidelines-2021
2. https://www.sciencedirect.com/science/article/pii/S0300957221000551
3. https://cprguidelines.eu/
4. https://www.erc.edu/
5. https://pubmed.ncbi.nlm.nih.gov/33773825/