• Colton Margus, Ashish Correa, William Cheung, Erika Blaikie, Kevin Kuo, Adam Hockensmith, David Kinas, and Trent She.
• Department of Emergency Medicine, Mount Sinai St. Luke's and Mount Sinai West, Icahn School of Medicine, New York, NY. Electronic address: colton.margus@gmail.com.
• Ann Emerg Med. 2020 Feb 1; 75 (2): 257-260.

AbstractStellate ganglion blockade has been previously suggested as a treatment option for intractable ventricular arrhythmia; however, its use in emergency department management of pulseless arrest with shockable rhythm has not been described. We report the case of a 65-year-old man brought in by ambulance who complained of chest pain and received an out-of-hospital ECG suggestive of anterior-wall ST-segment elevation myocardial infarction. Shortly after arrival, the patient became unresponsive, with no palpable pulse, and was found to be in ventricular fibrillation. The patient's ventricular fibrillation persisted despite repeated attempts at standard and double sequential defibrillation, multiple rounds of epinephrine, and amiodarone, magnesium, and bicarbonate. After these interventions were exhausted, a stellate ganglion blockade was conducted after an ultrasonographically guided paratracheal approach. Return of spontaneous circulation was noted after the next defibrillation and pulse check, achieved after a total of 42 minutes of active cardiopulmonary resuscitation. The patient ultimately had both sufficient neurologic activity and hemodynamic recovery for emergency percutaneous coronary intervention of the culprit left anterior descending artery. This positive outcome is multifactorial but suggests sympathetic blockade as a possible adjunctive therapy in the setting of sustained pulseless ventricular storm.Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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