Make it two: A case report of dual sequential external defibrillation

Abstract

Dual sequential external defibrillation (DSED) is the process of near simultaneous discharge of two defibrillators with differing pad placement to terminate refractory arrhythmias. Previously used in the electrophysiology suite, this technique has recently been used in the emergency department and prehospital setting for out-of-hospital cardiac arrest (OHCA). We present a case of successful DSED in the emergency department with neurologically intact survival to hospital discharge after refractory ventricular fibrillation (RVF) and review the putative mechanisms of action of this technique.

Beyond the Limit: Double Sequential Defibrillation as an Alternative Therapy for Refractory Ventricular Fibrillation

“…The outcomes of this case suggest the DSD may be of benefit in terminating refractory VF and achieving temporary or sustained ROSC, but the benefit of achieving temporary or sustained ROSC in refractory VF should be weighed against ischemic burden and progressive myocardial dysfunction imposed during resuscitation [26,27]. Our case is similar to previously described cases in which the patients have remained in refractory VF to multiple SD shocks before receiving DSD [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Likewise, we find similarities between the outcome in this case and the results described by Cabañas et al on the first case series published on DSD in OHCA.…”

“…Several case reports and case series have been published in recent years supporting the use of DSD as an alternative treatment for refractory VF as there appears to be a trend of promising outcomes [10][11][12][16][17][18][19][20][21][22][23][24]. Coronary artery disease (CAD) is the most common reversible cause in patients with VF/pVT OHCA [25].…”

“…There are currently no firm guidelines regarding the treatment of refractory VF. Double sequential defibrillation (DSD) is an approach that has been proposed as an alternative treatment for refractory VF as there appears to be a trend of promising outcomes, including termination of refractory VF, sustained ROSC, increased short term survival and favorable outcomes to hospital discharge [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. We report a case of prolonged resuscitation of an 72-year-old man who developed pulseless ventricular tachycardia (pVT) that progressed to refractory VF terminated by DSD.…”

Right time, right place, and right direction: First reported use of dual simultaneous external defibrillation in Hong Kong

“…2 All five patients of 2990 consecutive patients in routine electrophysiologic studies who experienced refractory VF were successfully resuscitated using DSED after unsuccessful standard defibrillation. Thereafter, there are numerous case reports worldwide demonstrating the success of this technique with neurologically intact survival; [3][4][5] and as a result, several emergency medical services systems have begun to implement DSED. [6][7][8] In Cabañas et al's case series, 6 return of spontaneous circulation was achieved in 7 out of 10 patients, but no survivors at the end.…”

Dual defibrillation in patients with refractory ventricular fibrillation

“…Search terms included: "Heart Arrest", "Electric Countershock", "Ventricular Fibrillation", "Out-of-hospital Cardiac Arrest", "Cardiac arrest", "Defibrillation", "Double Sequential Defibrillation", "Refractory Ventricular Fibrillation", "Dual Shock", "Dual Defibrillation", "Double Simultaneous Defibrillation". The search revealed 12 published papers on the use of double sequential defibrillation in refractory ventricular fibrillation in the setting of cardiac arrest; describing a total of 38 cases [8][9][10][11][12][13][14][15][16][17][18][19]. Study selection was accomplished through 2 levels of study screening.…”