Incessant ventricular fibrillation is difficult to manage. The mainstays of treatment include:

  • LUCAS CPR and ResQPod impedance threshold device
  • Multiple defibrillations
  • Amiodarone
  • Magnesium
  • Lidocaine
  • Esmolol

We have previously explored the option of using high energy defibrillations for this situation.

A novel technique which has been discussed in the literature is the stellate ganglion block. The stellate ganglion is part of the sympathetic chain formed by the inferior cervical and first thoracic ganglia, and provides sympathetic innervation to the upper extremities, head, neck, and heart. The procedure can be performed blindly, but usually done under fluoroscopy for reflex sympathetic dystrophy by pain specialists. Direct ultrasound guidance may allow this procedure to be performed with accuracy during resuscitation efforts. By blocking the sympathetic output, to the heart there is the possibility of ceasing the ventricular storm. There is a risk however of residual left ventricular dysfunction.

External landmarks and probe placement for performing an ultrasound-guided stellate ganglion block

Figure 1. External landmarks and probe placement for performing an ultrasound-guided stellate ganglion block.