VentricularFibrillation.com.au

In Australia, survival from VF cardiac arrest depends on immediate action:

1. Recognise Cardiac Arrest - No movement, No response, No breathing or occasional gasps.
2. Get help - Sout for HELP!, Call 000, Send someone to get a defibrillator.
3. Start and maintain CPR - Provide CPR to help maintain blood flow to the brain.
4. Defibrillate as soon as possible - Pads on ASAP. Defibrillation is the only way to restart a heart.
5. Early Ambulance Care - The ambulance team provide an advanced extra cardiac care.

Every minute without defibrillation reduces survival by about 7–10%. Early bystander CPR and AED use are the strongest predictors of survival with good neurological recovery.

First Aid (DRSABCD):

1. Danger – check safety.
2. Response – check if the person is responsive; if not responsive, step 3.
3. Send for help – call 000 immediately.
4. Airway – open and check airway, clear if necessary.
5. Breathing – if not breathing normally or only occasional gasps, start CPR.
6. CPR – compressions at 100–120/min, depth 1/3 of chest (~5 cm in adults). Ratio 30:2 if trained; continuous compressions if not comfortable giving breaths.
7. Defibrillation – apply AED pads as soon as possible, follow prompts, deliver shock if advised, and resume CPR immediately after each shock is given.

Paramedic/clinical care:

• Defibrillation is the key treatment.
  • Biphasic defibrillators: first shock 200 J, escalate to maximum if unsuccessful.
  • Monophasic (rare now): 360 J.
• High-quality CPR between shocks with minimal interruption.
• Adrenaline (epinephrine) 1 mg IV/IO every 3–5 minutes.
• Amiodarone 300 mg IV/IO after the 3rd shock, with an additional 150 mg if VF persists. Lidocaine is an alternative.
• Identify and treat reversible causes (the 4 Hs and 4 Ts):
  • Hypoxia, Hypovolaemia, Hypo-/hyperkalaemia & metabolic causes, Hypothermia
  • Tension pneumothorax, Tamponade, Toxins/poisons, Thrombosis (coronary or pulmonary)

If someone collapses, is unresponsive, not breathing normally:

• Call 000 – get emergency help straight away.
• Start CPR immediately – push hard and fast in the centre of the chest (100–120/min, ~5 cm deep in adults).
  • If trained: 30 compressions : 2 rescue breaths.
  • If untrained: continuous compressions.
• Apply an AED (Automated External Defibrillator) as soon as possible.
  • Pads on ASAP
  • Follow the prompts.
  • If “Shock advised”: press the button (or allow the AED to shock automatically).
  • Resume CPR immediately after the shock.
  • Many AEDs will analyse the patient each 2 minutes and offer a shock if appropriate.

💡 Early CPR + early defibrillation = the only way to save a VF patient before paramedics arrive.

Once trained personnel arrive:

• Continue CPR with minimal interruptions.
• Defibrillation:
  • Biphasic defibrillator: 200 J (escalating to max if required).
  • Monophasic: 360 J.
• Adrenaline (epinephrine): 1 mg IV/IO every 3–5 min (after 2nd shock and every 2nd loop).
• Amiodarone: 300 mg IV/IO bolus after 3rd shock; additional 150 mg if VF persists. (Lidocaine is an alternative if amiodarone not available.)
• Advanced airway management if skilled staff available (ET tube, supraglottic airway, or bag-mask with oxygen).
• Identify and treat reversible causes (the 4 Hs and 4 Ts):
  • Hypoxia, Hypovolaemia, Hypo-/hyperkalaemia & metabolic, Hypothermia
  • Tension pneumothorax, Tamponade, Toxins/poisons, Thrombosis (coronary/pulmonary)