#EMConf: Beyond ACLS - VFib


  • Amiodarone and Lidocaine have minimal effect over placebo in VT/VF (NEJM article from 2016)
  • Amiodarone remains in the ACLS guidelines and you can consider it after a couple of defibrillations since there remains some uncertainty.

Refractory VTach/ VFib:

  • For refractory VF/VT, consider Esmolol. A single center retrospective trial suggested that there was benefit in treating refractory VF/VT with it. 
  • Double sequence defibrillation is a nice idea but be cautious as there is minimal data for the same and there is some concern for damage to defibrillators. 



Kudenchuk, et al, Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest, NEJM, 2016.

Lee et al, Refractory ventricular fibrillation treated with esmolol, Resuscitation, 2016.