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A case of refractory ventricular fibrillation successfully treated with low-dose esmolol
  1. Charles W Hwang,
  2. Ginger Gamble,
  3. Michael Marchick and
  4. Torben K Becker
  1. Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Charles W Hwang, c7places{at}


Current advanced cardiac life support (ACLS) guidelines for the management of ventricular fibrillation (VF) and pulseless ventricular tachycardia is defibrillation. However, refractory VF, which is defined as VF that persists despite three defibrillation attempts, is challenging for all ACLS providers; the best resuscitation strategy for patients that persist in refractory VF remains unclear. We report on a 51-year-old man who presented to the emergency department with chest pain and subsequently went into witnessed VF cardiac arrest. Despite standard ACLS management consisting of high-quality cardiopulmonary resuscitation, serial epinephrine and serial defibrillation, the return of spontaneous circulation (ROSC) was unable to be achieved. Double sequential defibrillation (DSD) was attempted multiple times unsuccessfully. After administration of low-dose esmolol, he immediately achieved ROSC. DSD and β-blockade are increasingly recognised in the literature and practice for refractory VF. However, to the best of our knowledge, this is the first case of refractory VF that responded to low-dose esmolol β-blockade.

  • arrhythmias
  • cardiovascular system
  • emergency medicine
  • resuscitation
  • intensive care

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  • Contributors CWH: developed the concept. CWH, GG, TKB: drafted the manuscript. CWH, GG, TKB, MRM: edited, proofread and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.