Refractory ventricular fibrillation (VF)/pulseless VF (pVF)/ polymorphic ventricular tachycardia (Torsade de pointes)

The ANZCOR Guideline on Medications and Fluids in Paediatric Advanced Life Support reported hypomagnesaemia may cause life-threatening ventricular tachyarrhythmia, particularly when associated with hypokalaemia. Magnesium is the preferred antiarrhythmic treatment for polymorphic ventricular tachycardia (Torsade de pointes – “Twisting of peaks”) due to acquired or congenital prolonged QT interval syndromes [LOE IV]. Neither increased return of spontaneous circulation (ROSC) nor survival in adults has been demonstrated in treatment of VF with magnesium [LOE IV]. The intravenous or intraosseous bolus dose of magnesium sulphate is 0.1-0.2 mmol/kg followed by an infusion of 0.3mmol/kg over 4 hours. [15]