Q: In Hypothermia induced Ventricular fibrillation which cardiac medicine is preferred and which one may harm the patient?


Answer: Bretylium (5 mg/kg initially) is recommended for any hypothermic patient manifesting significant new frank dysrhythmia. However, bretylium has a worldwide shortage and may not be available. Relying on Amiodarone or Lidocaine are the next choices.

Procainamide may induce more ventricular fibrillation and should be avoided.

Defibrillation should also be performed simultaneously. Defibrillate at 2 J/kg (or the biphasic equivalent) if patient remains in ventricular fibrillation or ventricular tachycardia. Success rates of defibrillation are low if the core temperature is less than 32°C and should be performed with rise in body temperature. Actually, because many arrhythmias convert spontaneously upon rewarming, aggressive therapy of minor arrhythmias is not warranted. Transient ventricular arrhythmias should be ignored. This also is true of bradycardia or atrial arrhythmias.

The cornerstone of treatment is rewarming the patient