Pulseless Ventricular Tachycardia (VT) Treatment

Introduction

Pulseless ventricular tachycardia (VT) is a life-threatening cardiac arrhythmia requiring immediate intervention. It is classified as a shockable rhythm in cardiac arrest, meaning defibrillation is the primary treatment.

Steps of Treatment

1. Confirm the Diagnosis

  • Pulseless VT presents with rapid ventricular contractions but no effective cardiac output.
  • The patient is unresponsive and has no detectable pulse.

2. Initiate Basic Life Support (BLS)

  • Begin chest compressions immediately (rate: 100-120 per minute, depth: at least 5 cm/2 inches for adults).
  • Ensure high-quality CPR with full chest recoil and minimal interruptions.
  • Provide oxygen and use a bag-valve mask with a high concentration of oxygen.

3. Defibrillation

  • As soon as an automated external defibrillator (AED) or manual defibrillator is available, deliver a shock:
    • Biphasic: 120-200 J (manufacturer-specific)
    • Monophasic: 360 J
  • Resume CPR immediately after the shock for 2 minutes before checking rhythm again.
  • Repeat defibrillation as needed every 2 minutes if VT persists.

4. Advanced Cardiac Life Support (ACLS) Measures

  • Epinephrine (1 mg IV/IO every 3-5 minutes) to enhance coronary perfusion.
  • Amiodarone (300 mg IV bolus, then 150 mg if needed) or Lidocaine as an alternative antiarrhythmic.
  • Reassess and treat reversible causes (the 5 H’s & 5 T’s):
    • Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia
    • Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary/coronary)

5. Post-Resuscitation Care

  • If return of spontaneous circulation (ROSC) occurs, initiate targeted temperature management (TTM) to improve neurological outcomes.
  • Identify and treat the underlying cause of VT.
  • Consider placing an implantable cardioverter-defibrillator (ICD) in patients at high risk of recurrence.

Conclusion

Pulseless VT is a medical emergency that requires rapid CPR, immediate defibrillation, and adherence to ACLS protocols. Early intervention significantly improves survival and neurological outcomes.

Source recommendations

1. 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

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

2. European Resuscitation Council Guidelines 2021

  1. https://cprguidelines.eu/guidelines-2021
  2. https://www.sciencedirect.com/science/article/pii/S0300957221000551
  3. https://cprguidelines.eu/
  4. https://www.sciencedirect.com/science/article/pii/S0300957221000630
  5. https://pubmed.ncbi.nlm.nih.gov/33773835/

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