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Refractory ventricular fibrillation — DIPIMC MCQ

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HardResuscitationRefractory ventricular fibrillationDIPIMCDipIMC

An adult in cardiac arrest remains in ventricular fibrillation despite five shocks, high-quality CPR, adrenaline given after the third shock, and an initial 300 mg of amiodarone. Pad position and contact have been checked. What is the most appropriate next pharmacological and technical step?

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Correct answer: D — Give a further 150 mg of amiodarone and consider repositioning the pads

In refractory ventricular fibrillation, a further 150 mg of amiodarone is given after the fifth shock, and changing pad position (for example to an anterior-posterior configuration) may improve the delivered current. Reducing energy or abandoning shocks reduces the chance of successful defibrillation. Atropine has no role in the management of a shockable arrest. Pearl: consider and treat reversible causes and ensure compression quality before attributing failure to the rhythm alone.

Reference: Resuscitation Council UK Guidelines 2025 (Adult Advanced Life Support)