Abstract
Background
Refractory ventricular dysrhythmia, or electrical storm, is a cardiac condition consisting
of three or more episodes of ventricular dysrhythmia resistant to treatment within
a 24-hour period. These dysrhythmias carry high morbidity and mortality if not diagnosed
and abated promptly. When traditional resuscitative algorithms fail to return a patient
to a perfusing rhythm, providers need to consider other, more novel techniques to
terminate these dangerous dysrhythmias. One approach is the use of a stellate ganglion
block, which has been documented in the literature only a handful of times for its
resuscitative use in cardiac arrest.
Case Series
This case series details two cases from an urban emergency department (ED) in a large
metropolitan city, where the use of ultrasound-guided stellate ganglion blocks during
cardiac arrest provided successful ablation of the tachydysrhythmia. The first case
involves a patient who went into cardiac arrest while in the ED and was found to be
in refractory pulseless ventricular tachycardiawhile. The second case describes a
patient who went into a witnessed out-of-hospital cardiac arrest while with emergency
medical services.
Why Should an Emergency Physician Be Aware of This?
The stellate ganglion block is a procedure currently being used as a treatment modality
for a variety of neurologic, psychological, and cardiac conditions. This intervention
may provide a viable and lifesaving option for emergency physicians to adopt when
traditional resuscitative algorithms fail to break resistant ventricular tachydysrhythmias.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The rationale and the role of left stellectomy for the prevention of malignant arrhythmias.Ann N Y Acad Sci. 1984; 427: 199-221
- Double sequential defibrillation for out-of-hospital refractory ventricular fibrillation: a scoping review.Am J Emerg Med. 2019; 38: 1211-1217
- Sudden cardiac deaths have higher proportion of left stellate ganglionitis.Forensic Sci Med Pathol. 2022; 18: 156-164
- Heart disease and stroke statistics—2020 update: a report from the American Heart Association.Circulation. 2020; 141: E139-E596
- Treating electrical storm: sympathetic blockade versus advanced cardiac life support-guided therapy.Circulation. 2000; 102: 742-747
- Survival in ventricular fibrillation with emphasis on the number of defibrillations in relation to other factors at resuscitation.Resuscitation. 2017; 113: 33-38
- Efficacy of stellate ganglion blockade in managing electrical storm: a systematic review.JACC Clin Electrophysiol. 2017; 3: 942-949
- Combination of multidisciplinary therapies successfully treated refractory ventricular arrhythmia in a STEMI patient: case report and literature review.Healthcare (Basel). 2022; 10: 507
- Calming the storm - stellate ganglion block in refractory ventricular arrhythmia in the emergency department.Am J Emerg Med. 2021; 45 (e5–8): 685
- Stellate ganglion block as rescue therapy in drug-resistant electrical storm.Ann Card Anaesth. 2021; 24: 415-418
- Stellate ganglion nerve block by point-of-care ultrasonography for treatment of refractory infarction-induced ventricular fibrillation.Ann Emerg Med. 2020; 75: 257-260
- Stellate ganglion blockade: an intervention for the management of ventricular arrhythmias.Curr Hypertens Rep. 2020; 22: 100
- Resuscitating resuscitation: advanced therapies for resistant ventricular dysrhythmias.J Emerg Med. 2021; 60: 331-341
Hodgson R, Magid B. Stellate Ganglion via Ultrasound-Guidance.
- Family presence during resuscitation: a qualitative analysis from a national multicenter randomized clinical trial.PLoS One. 2016; 11e0156100https://doi.org/10.1371/journal.pone.0156100
- Psychological effect of witnessed resuscitation on bereaved relatives.Lancet. 1998; 352: 614-617
Article info
Publication history
Published online: March 13, 2023
Accepted:
March 7,
2023
Received in revised form:
January 29,
2023
Received:
December 7,
2022
Footnotes
RECEIVED: 7 December 2022; FINAL SUBMISSION RECEIVED: 29 January 2023; ACCEPTED: 7 March 2023
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.