Eastern Cardiothoracic Surgical Society

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Bolus Potassium in Frustrated Ventricular Fibrillation Storm
Ahmed Elmahrouk, Ehab Elghaysha, Ahmed Jamjoom, Uthman Aluthman.
King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.

OBJECTIVE: Since long time ago; ventricular fibrillation (VF) is a well-known ominous complication of ischemic heart disease. While firm structured algorithm has been adopted for its management, yet its mortality rate remains high.
METHODS: This is a case report of a 46-year-old gentleman who was a victim of recurrent cardiac arrest in the ward while awaiting for emergency coronary artery bypass surgery, intra-operatively, he had recurrent VF and was sent to CSICU with open chest on ECMO support with IABP and epicardial pacemaker. Post-operatively still had malignant ventricular arrhythmia with dropping of his EF to less than 10%. Latest episodes of VF was long lasting more than an hour (while was on ECMO support) with failure of various antiarrhythmic medications to abort the arrhythmia
RESULTS: Finally, a decision was taken to give him 20 mmol of KCL IV push aiming at producing a state of asystole but the rhythm changed to sinus rhythm.
CONCLUSIONS: This report tried to spotlight the fact that the optimum management of ventricular fibrillation is still lacking and necessitates further studies and researches. The appropriate effective dose of potassium replacement during VF needs to be reconsidered in patient with persistent VF, as nearly all studies were done on non-fibrillating heart.


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