Emergency Management of Ventricular Fibrillation

Introduction:

Ventricular fibrillation (V-fib) is a type of life-threatening heart rhythm disturbance. These usually lead to sudden cardiac arrests in which the heart beats irregularly and eventually stops beating. The heart’s lower chambers or ventricles are responsible for pumping blood to all body parts and the lungs. In ventricular fibrillation, the heart’s lower chambers quiver irregularly and cannot pump blood efficiently, affecting breathing and consciousness. It can lead to cardiac arrests and death if emergency care is not provided. Prompt heart rhythm analysis, defibrillation, and cardiopulmonary resuscitation (CPR) can help restore normal heart rhythm and function.

What Happens in Ventricular Fibrillation?

The following factors can cause ventricular fibrillation:

• Cardiac diseases.

• Electrical irregularities.

• Scars or damage to the heart tissue.

• Thicker heart tissues.

• Chest trauma.

• Pharmaceuticals.

• Electrolyte imbalances.

• Medications.

• Blood vessel abnormalities.

The electrical signal system of the heart malfunctions and the heart’s lower chambers quiver irregularly, triggering sudden cardiac arrest, and the heart suddenly stops beating, causing a medical emergency. As a result, the heart does not pump blood to the organs, body, brain, and lungs. Within seconds, the patient becomes unconscious, unresponsive, and gasps for breath. Such cardiac arrests lead to collapse and death within minutes if treatment is not initiated immediately.

What Are the Warning Signs of Ventricular Fibrillation?

Ventricular fibrillation can cause fluttering, racing heart, nausea, weakness, shortness of breath, palpitations, chest pain and discomfort before the patient collapses due to sudden cardiac arrest. Sometimes ventricular fibrillations and cardiac arrest have no warning signs. Therefore, one must suspect sudden cardiac arrest (due to ventricular fibrillation) if the following signs occur in an individual:

• Cardiac arrest.

• Gasps for breath.

• No movement.

• No blink.

• Unconsciousness.

• Collapses suddenly.

• Non reacting.

• Loss of responsiveness.

What Should Be Done if a Person Collapses Due to Ventricular Fibrillation and Cardiac Arrest?

In case of ventricular fibrillation and cardiac arrest, one must follow the following steps immediately till emergency service arrives to save the person:

1. Stay calm and check for the patient's response after ensuring scene safety.

2. Call for help immediately (emergency medical services).

3. Arrange for an automated external defibrillator (AED). An individual with shockable cardiac rhythms, such as ventricular fibrillation and pulseless ventricular tachycardia, is shocked by a defibrillator via the chest. Defibrillation, another name for electrical shock, helps to stop the heart's aberrant rhythm and revive it with a regular, organized rhythm or normal heartbeat. Automated external defibrillators are portable, small, and lightweight devices that deliver an electric shock to the heart through the chest in case of cardiac arrests due to ventricular fibrillation. Anyone with little training can use these.

4. Make sure the patient is breathing. Cardiopulmonary resuscitation (CPR) should begin with compressions if the patient is not breathing or gasping.

5. Push or squeeze the patient's chest in the middle (100 to 120 pushes per minute, around two inches deep). One must allow the chest to settle back into place after each thrust.

6. Every 30 compressions, check the patient's airway and administer rescue breaths (if trained in cardiopulmonary resuscitation). If not trained, just keep doing chest compressions.

7. Use the automated external defibrillator to deliver shocks and check the rhythm while continuing CPR until aid. Within the first, three to ten minutes of cardiac arrest, defibrillation, and urgent chest compression must be started.

8. The person’s chance of surviving drops by seven to ten percent for every minute a normal heartbeat is not restored.

How Is Heart Rhythm Analysis Important?

Heart Rhythm Analysis With Automated External Defibrillators:

Automated external defibrillators automatically perform the heart rhythm analysis, so the operators do not need to read or interpret the patient’s heart rhythm. These are automated and detect irregular heart rhythms. They deliver a controlled shock to patients with shockable rhythms such as ventricular fibrillation. In the case of non-shockable rhythms, no shock is delivered by the device.

How Are Ventricular Fibrillation Emergencies Managed?

Ventricular fibrillation is managed following the adult cardiac arrest algorithm guidelines for resuscitation. The steps include the following:

1. Early effective cardiopulmonary resuscitation with oxygen administration and defibrillator or monitor attachment. This step is key to ensuring that the vital organs, such as the heart and brain, get sufficient oxygen and blood flow.

2. Once heart rhythm analysis is done, and the rhythm is identified as ventricular fibrillation, the recommended shock dose is delivered to normalize the heart rhythm.

3. Once the shock is delivered, cardiopulmonary resuscitation is done for two minutes. The health care professionals also try to assess the underlying cause to treat the patients.

4. The heart rhythm is reassessed after two minutes of cardiopulmonary resuscitation. If ventricular fibrillation remains, another shock is delivered, followed by two-minute cardiopulmonary resuscitation.

5. The heart rhythm is checked again; if ventricular fibrillation continues, medications are given intravenously. The emergency drug Epinephrine is the first medication given. This is repeated every three to five minutes. Finally, Amiodarone (300 milligrams) is administered if epinephrine is ineffective.

6. Defibrillation (shock delivery) and medications are administered alternatingly between high-quality cardiopulmonary resuscitation until the patient’s heart rhythm normalizes (return of spontaneous circulation) or until the cardiac arrest team decides it is time to stop resuscitation.

7. Patients who survive cardiac arrests due to ventricular fibrillation have a higher risk of another one in the future. So, the health care provider will perform certain tests to check the underlying causes and suggest measures and treatment options to prevent ventricular fibrillation. These include:

• Medications to keep the heart rhythm normal (antiarrhythmic medicines).

• Small battery-powered devices such as cardioverter-defibrillators (ICDs) may be implanted in the chest to detect irregular heart rhythms and to deliver a shock to bring the rhythm back to normal.

Conclusion

Since ventricular fibrillation is a life-threatening condition, quick, immediate intervention based on the heart rhythm is required to address cardiac arrests caused by it. The survival of the patient with ventricular defibrillation depends on early recognition of the symptoms, calling for emergency assistance, appropriate management with early defibrillation (shock), high-quality cardiopulmonary resuscitation (with little interruption of chest compressions), and treatment of reversible causes. Defibrillation, cardiopulmonary resuscitation (CPR), and immediate heart rhythm analysis can all assist in returning the heart's rhythm and function to normal.