1Emergency Medicine Resident, Department of Emergency Medicine, SRM Medical College Hospital and Research Center. ORCID ID: 0009000781440364. Email: dr9774@srmist.edu.in
2Emergency Medicine Resident, Department of Emergency Medicine, SRM Medical College Hospital and Research Center. ORCID ID: 0009000209849249. Email: pk6342@srmist.edu.in
3Assistant Professor, Department of Emergency Medicine, SRM Medical College Hospital and Research Center. ORCID ID: 0000000259795288. Email: rjklraja005@gmail.com
4*Professor and Head, Department of Emergency Medicine, SRM Medical College Hospital and Research Center. ORCID ID: 0009000914568098. Email: rajak3@srmist.edu.in
Background: Electrical storm, characterized by recurrent episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF), is a life-threatening complication of acute coronary syndrome (ACS) and is associated with significant mortality. Standard management includes prompt defibrillation, antiarrhythmic therapy, and urgent coronary revascularization. However, some patients develop refractory ventricular arrhythmias despite optimal Advanced Cardiac Life Support (ACLS) measures. Stellate ganglion block (SGB), which interrupts cardiac sympathetic outflow, has been proposed as a potential adjunctive therapy for refractory ventricular arrhythmias.
Methods: We report a retrospective case series of three patients presenting with ACS complicated by refractory ventricular arrhythmias who were managed with ultrasound-guided left stellate ganglion block in the emergency department of a tertiary care hospital. All patients developed persistent VT or VF during resuscitation despite multiple defibrillation attempts and standard ACLS pharmacologic therapy. Clinical data were collected from medical records, including patient presentation, resuscitation details, coronary angiographic findings, and clinical outcomes.
Results: The three patients (aged 37-45 years) experienced cardiac arrest due to refractory ventricular arrhythmias during the course of ACS. After multiple unsuccessful defibrillation attempts (6-7 shocks), ultrasound-guided left SGB using 10 mL of 0.25% bupivacaine was performed as a rescue sympatholytic intervention. In each case, return of spontaneous circulation occurred after defibrillation delivered following SGB administration. Subsequent coronary angiography revealed significant culprit coronary lesions requiring percutaneous coronary intervention. All patients were successfully stabilized and discharged with favorable neurological outcomes.
Conclusion: These cases suggest that emergency department-based stellate ganglion block may represent a feasible adjunctive intervention for refractory ventricular arrhythmias in ACS, potentially serving as a bridge to definitive coronary revascularization. Further prospective studies are required to better define its role and optimal timing in resuscitation settings.
Keywords: NA
How to cite this article: Raaj D, Prahadheesh, Rajakali R, Rajarajeswaran. Stellate Ganglion Block as a Rescue Therapy for Refractory Arrhythmias in the Emergency Setting: A Case Series. Int J Drug Deliv Technol. 2026;16(1s): 1054-1058. DOI: 10.25258/ijddt.16.1s.116
Source of support: Nil.
Conflict of interest: None