The technique of reversing ventricular fibrillation: improve the odds of success with this five-phase approach.
Early, repeated defibrillation is the key to managing ventricular fibrillation (VF).  To maximize the likelihood of success, use this five-phase approach, modified from the advanced cardiac life support protocols.  Phase I: When a patient is found in VF and with no pulse or signs of life, attempt electrical reversion with a 200-wsec shock, followed if necessary by a 300-wsec and a 360-wsec shock.  Phase II: Manage reversible causes of VF with orotracheal intubation, hyperventilation, and epinephrine.  Phase III: Use intravenous lidocaine aggressively, followed by a 360-wsec shock.  Phase IV: Give bretylium and magnesium sulfate by intravenous push, again followed by a 360-wsec shock.  Phase V: Treat refractory VF with repeated 360-wsec shocks, and give further doses of the anti-arrhythmic agents.
Slovis
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Vanderbilt University School of Medicine, Nashville, Tennessee.
Wrenn
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D001949:Bretylium Compounds / Q000008:administration & dosage; D002985:Clinical Protocols; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D004837:Epinephrine / Q000008:administration & dosage; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D008012:Lidocaine / Q000008:administration & dosage; D008278:Magnesium Sulfate / Q000008:administration & dosage; D012307:Risk Factors; D014693:Ventricular Fibrillation / Q000628:therapy*