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VT Storm


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*Details have been changed to protect patient identity*

Had a patient transferred in from a sister hospital a while back. Gentleman in his 40s, hx of NICM with a VF arrest around 5 years beforehand, now with a DC AICD. I'm unsure of why the pacer portion was active.

Came in with "feeling odd" and "chest flutters". Turns out had received 4 ICD discharges for VT>VF. Loaded with amio+infusion. Had 3 more discharges, appears to be PVC mediated. Loaded with lido+infusion, 2 more. Decision made to intubate and transfer for semi-emergent ablation (weird term).

He was good for the first couple hours...followed by 86 ICD discharges. I reloaded amio+lido, thought about procainamide, multiple metoprolol doses. Unfortunately the ICD either ran out of juice or simply stopped functioning leading to several prolonged arrests. When morning came around they cath'd him, placed a support device and went to the EP lab, unfortunately arrested again and decision made to halt resus.

One of the more frustrating nights I've had. Questions for the group:

Have you ever used procainamide for VT storm?

Experience using propranolol or esmolol rather than metoprolol?

Ever seen a stellate ganglion block actually performed (I've seen one) or know if there is utility in PVC mediated storm?

I know we have some Cards-CC folks on here, feel free to tag them if you remember who they are!

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