Pulseless ventricular tachycardia interventions

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

Immediate defibrillation is the main intervention for pVT.

Defibrillation[1][2]

Defibrillation^[1]^[2]

As opposed to other unstable Ventricular tachycardia, PVT should be managed with immediate defibrillation. A high energy defibrillator (150-200 J on biphasic and 360 J on monophasic) should be used for the initial shock dose, followed by an equal or higher shock dose for successive shocks
5 CPR cycles each containing 30 chest compressions and 2 breaths should be done after the first shock is delivered. Each subsequent shock should be followed by airway management with Oxygen delivery, and IV access with vasopressors.

Adult Cardiac Arrest

Start CPR
Give oxygen
Attach monitor/defibrillator

Rhythm shockable?

Yes

No

VF/pVT

Asystole/PEA

Shock

Box A:

CPR 2 min
IV/IO access

Rhythm shockable?

No

Yes

Shock

Box B:

CPR 2 min
Epinephrine every 3-5 min
Consider advanced airway
and capnography

Box C:

CPR 2 min
IV/IO access
Epinephrine every 3-5 min
Consider advanced airway
and capnography

Rhythm shockable?

No

Rhythm shockable?

Yes

No

Shock

CPR 2 min
Amiodarone or Lidocaine
Treat reversible causes

Box D:

CPR 2 min
Treat reversible causes

Go back to box A

No

Rhythm shockable?

Yes

Shock
Then, go to box A or box B

If no signs of return of spontaneous circulation:
Go to box C or box D

If return of spontaneous circulation:
Start post cardiac arrest care

Adapted from Adult Cardiac Arrest Algorithm – 2018 Update^[3]

References