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Stellate Ganglion Blocks (SGB) have been reported in case reports as a last-line treatment for patients with refractory ventricular arrhythmias.
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A recent multicenter study evaluated the efficacy and safety of SGB in managing refractory ventricular arrhythmias.
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The study included 117 critically ill patients, with 9 on ECMO, 5 with Impella devices, and 15 with LVADs.
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70% were given long-acting bupivacaine, 28% were given ropivacaine and 1 patient received lidocaine.
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SGBs were primarily performed by anesthesiologists during short periods of when the patients were not in ventricular arrhythmia
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The median 24-hour episodes of VT/VF decreased from 9.0 (interquartile range [IQR]: 3.0–31.0) pre-SGB to 1.0 (IQR: 0.0–5.0) post-SGB.
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2 patients had complications; recurrent laryngeal nerve block with resultant hoarseness and brachial plexus block.
Limitations: This study was conducted in a controlled setting (ie not in active arrest, not in the emergency department) and involved a selective cohort. Randomized controlled trials (RCTs) are needed to validate these findings.
References
Chouairi F, Rajkumar K, Benak A, Qadri Y, Piccini JP, Mathew J, Ray ND, Toman J, Kautzner J, Ganesh A, Sramko M, Fudim M. A Multicenter Study of Stellate Ganglion Block as a Temporizing Treatment for Refractory Ventricular Arrhythmias. JACC Clin Electrophysiol. 2024 Apr;10(4):750-758. doi: 10.1016/j.jacep.2023.12.012.