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UIHC EMS Fellow Dr. Alex Colgan joins the podcast to discuss the pathophysiology, latest literature, and considerations of refractory Vfib cardiac arrest. References: Bell SM, Lam DH, Kearney K, Hira RS. Management of Refractory Ventricular Fibrillation (Prehospital and Emergency Department). Cardiol Clin. 2018 Aug;36(3):395-408. doi: 10.1016/j.ccl.2018.03.007. PMID: 30293606. Esmolol Gottlieb M, Dyer S, Peksa GD. Beta-blockade for the treatment of cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia: A systematic review and meta-analysis. Resuscitation. 2020 Jan 1;146:118-125. doi: 10.1016/j.resuscitation.2019.11.019. Epub 2019 Nov 29. PMID: 31790759. Miraglia D, Miguel LA, Alonso W. The Evolving Role of Esmolol in Management of Pre-Hospital Refractory Ventricular Fibrillation; a Scoping Review. Arch Acad Emerg Med. 2020 Feb 25;8(1):e15. PMID: 32259114; PMCID: PMC7130434. Amiodarone Dorian et al. “Amiodarone as Compared with Lidocaine for Shock-Resistant VF.” NEJM. 2002 Mar 21. 346: 884-890. (ALIVE trial) Kudenchuk, et al. “Amiodarone for Resuscitation after OOHCA due to VF.” NEJM. 1999 Sept 16; 341: 871-878. (ARREST trial) Kudenchuk, et al. “Amiodarone, Lidocaine, or Placebo in OOHCA.” NEJM. 2016 May 5; 374: 1711-1722. (ALPS) DSD Miraglia D, Miguel LA, Alonso W, Ayala JE. Double sequential defibrillation for out-of-hospital refractory ventricular fibrillation: A scoping review. Am J Emerg Med. 2020 Jun;38(6):1211-1217. doi: 10.1016/j.ajem.2019.12.047. Epub 2019 Dec 24. PMID: 31937443. ECMO Hira RS, Nichol G. Management of Refractory Ventricular Fibrillation: Extracorporeal Membrane Oxygenation or Epinephrine? JACC Basic Transl Sci. 2017 Jun 26;2(3):254-257. doi: 10.1016/j.jacbts.2017.04.001. PMID: 30062147; PMCID: PMC6034480. Reynolds, J. C., Grunau, B. E., Elmer, J., Rittenberger, J. C., Sawyer, K. N., Kurz, M. C., ... & Callaway, C. W. (2017). Prevalence, natural history, and time-dependent outcomes of a multi-center North American cohort of out-of-hospital cardiac arrest extracorporeal CPR candidates. Resuscitation. Sakamoto, et al. “ECPR v. conventional CPR in adults with OOHCA: a prospective observational study.” Resuscitation. 2014 Jun; 85(6):762-8. Stub, D., Bernard, S., Pellegrino, V., Smith, K., Walker, T., Sheldrake, J., ... & Cameron, P. (2015). Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation, 86, 88-94. Yannopoulos, D., Bartos, J. A., Raveendran, G., Conterato, M., Frascone, R. J., Trembley, A., ... & Wilson, R. F. (2017). Coronary artery disease in patients with out-of-Hospital refractory ventricular fibrillation cardiac arrest. Journal of the American College of Cardiology, 70(9), 1109-1117. Yannopoulos, et. Al. “Advanced reperfusion strategies for patients with OOHCA and rVF: a phase 2, single center, open-label, randomized control trial.” Lancet. 2020 Nov 13. 1807-1816. (ARREST trial)