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Cardiac arrest

Refractory VF rare with worse outcomes

Refractory ventricular fibrillation in out-of-hospital cardiac arrest: shock characteristics, predictors and clinical outcomes
Resuscitation · Added 3 August 2026

This registry study of 436 OHCA patients compared refractory VF (all three shocks failed to terminate, 5% of cases) versus recurrent VF, finding refractory VF patients had lower ROSC (41% vs 59%) and 30-day survival (23% vs 46%) with predictors including no CPR/AED before EMS, longer delay to first shock, and lower amplitude spectral area.

Study type

Registry

Design

Registry cohort with ECG waveform analysis (ARREST registry)

Participants

436 patients with VF at first three rhythm checks; 22 with refractory VF

Main finding

Refractory VF in 5% of cases; ROSC 41% vs 59% (RR 0.69, 95% CI 0.41-1.15) and 30-day survival 23% vs 46% (RR 0.49, 95% CI 0.23-1.08) versus recurrent VF; predictors included no bystander CPR/AED, longer delay to first shock, lower amplitude spectral area

Caveat

Only 22 refractory VF patients, so outcomes were underpowered and remain uncertain

Bottom line

Hypothesis-generating

Learning goal

Recognise the patient and rhythm factors that predict refractory ventricular fibrillation during out-of-hospital cardiac arrest resuscitation.

More

• Topic: Cardiac arrest
• Daily scan: 3 August 2026

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