What is Pulseless Arrest

Ventricular fibrillation (v-fib) and pulseless ventricular tachycardia (v-tach or VT) are lethal dysrhythmias that do not produce a pulse. Ventricular fibrillation is the most common initial dysrhythmia in cardiac arrest and will regress to asystole if not treated right away.

Pulseless Arrest Treatment

The treatment for ventricular fibrillation is rapid defibrillation. Every minute that defibrillation is delayed, the chance of survival is reduced by 10%.

The key steps to treating ventricular fibrillation are:

  • Rapid assessment to confirm cardiac arrest
  • Starting CPR
  • Applying the defibrillator and delivering the first shock as soon as possible

High quality CPR needs to be performed with as few interruptions as possible. Cycles of 30 compressions at a depth of 2 to 2.4 inches deep and at a rate of 100 to 120 per minute should be given, followed by two (2) breaths. The teammate performing compressions needs to be changed every 2 minutes to avoid fatigue.

After the initial shock, an IV or IO needs to be established to give medications.

  • The first medication to give is epinephrine, 1 mg 1:10,000 IV or IO push every 3-5 minutes
  • After the initial dose of epinephrine, a second shock should be given
  • Placing an advanced airway with capnography should be considered. Once an advanced airway is in place, CPR compressions become continuous at 100 to 120 compressions a minute, and one breath is given every 6 seconds
  • If the patient remains in persistent ventricular fibrillation after the initial shocks and epinephrine administration, the next medication to give is amiodarone at 300 mg via rapid IV or IO push
  • A 150 mg dose of amiodarone may repeated one time in 3-5 minutes
  • Successful treatment of ventricular fibrillation continues with high quality CPR, reassessing the patient’s cardiac rhythm every 2 minutes, delivering a shock if ventricular fibrillation is present, and giving medications as indicated