Multiple failed external defibrillation attempts during robot-assisted internal mammary harvest for myocardial revascularization

We describe multiple failed external defibrillation attempts via rescue defibrillation pads for ventricular fibrillation that occurred secondary to direct electrical current transmission through the pericardial sac from electrocautery during robot-assisted internal mammary harvest. Only after resumption of two-lung ventilation and decompression of the iatrogenic pneumothorax was the patient successfully defibrillated. Conditions necessary for robotic intrathoracic surgery may make defibrillation and resuscitation difficult if they become necessary.