Bench to bedside: resuscitation from prolonged ventricular fibrillation

Acad Emerg Med. 2001 Sep;8(9):909-24. doi: 10.1111/j.1553-2712.2001.tb01155.x.


Ventricular fibrillation (VF) remains the most common cardiac arrest heart rhythm. Defibrillation is the primary treatment and is very effective if delivered early within a few minutes of onset of VF. However, successful treatment of VF becomes increasingly more difficult when the duration of VF exceeds 4 minutes. Classically, successful cardiac arrest resuscitation has been thought of as simply achieving restoration of spontaneous circulation (ROSC). However, this traditional approach fails to consider the high early post-cardiac arrest mortality and morbidity and ignores the reperfusion injuries, which are manifest in the heart and brain. More recently, resuscitation from cardiac arrest has been divided into two phases; phase I, achieving ROSC, and phase II, treatment of reperfusion injury. The focus in both phases of resuscitation remains the heart and brain, as prolonged VF remains primarily a two-organ disease. These two organs are most sensitive to oxygen and substrate deprivation and account for the vast majority of early post-resuscitation mortality and morbidity. This review focuses first on the initial resuscitation (achieving ROSC) and then on the reperfusion issues affecting the heart and brain.

Publication types

  • Review

MeSH terms

  • Animals
  • Electric Countershock / adverse effects*
  • Humans
  • Myocardium / metabolism*
  • Reperfusion Injury / physiopathology
  • Resuscitation / methods*
  • Ventricular Fibrillation / therapy*