Prehospital Double Sequential Defibrillation: A Matched Case–Control Study

Abstract

Objectives: The goal of our study was to determine whether prehospital double sequential defibrillation (DSD) is associated with improved survival to hospital admission in the setting of refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT).Methods: This project is a matched case-control study derived from prospectively collected quality assurance/ quality improvement data obtained from the San Antonio Fire Department out-of-hospital cardiac arrest (OHCA) database between January 2013 and December 2015. The cases were defined as OHCA patients with refractory VF/pVT who survived to hospital admission. The control group was defined as OHCA patients with refractory VF/ pVT who did not survive to hospital admission. The primary variable in our study was prehospital DSD. The primary outcome of our study was survival to hospital admission.Results: Of 3,469 consecutive OHCA patients during the study period, 205 OHCA patients met the inclusion criterion of refractory VF/pVT. Using a predefined algorithm, two blinded researchers identified 64 unique cases and matched them with 64 unique controls. Survival to hospital admission occurred in 48.0% of DSD patients and 50.5% of the conventional therapy patients (p > 0.99; odds ratio = 0.91, 95% confidence interval = 0.40-2.1).Conclusion: Our matched case-control study on the prehospital use of DSD for refractory VF/pVT found no evidence of associated improvement in survival to hospital admission. Our current protocol of considering prehospital DSD after the third conventional defibrillation in OHCA is ineffective.

Double sequential external defibrillation versus standard defibrillation in refractory ventricular fibrillation: A systematic review and meta-analysis

“…The details are shown in the forest plot (Figure 2E). The Begg's Test resulted in P = 0.296 > 0.05, implying that there is no publication bias in the three studies (18,19,21). Double sequential external defibrillation (DSED) was not superior to standard defibrillation in terms of survival to good neurological outcomes in patients with RVF, and there was no significant difference between the two in good neurological recovery outcomes.…”

“…The six studies (4,8,14,17,19,21) were tested for heterogeneity (I 2 = 46.9% < 50%), and P = 0.094 < 0.1 of the Q-test, suggesting that the heterogeneity among the article selected for this study was statistically significant, and further examining L' Abbe Plot (Figure 2F) and Radial Plot (Figure 3B), The analysis of the study showed no difference between DSED and standard defibrillation in the return of spontaneous circulation.…”

Double (dual) sequential defibrillation for refractory ventricular fibrillation cardiac arrest: A systematic review

“…For the critical outcome of good neurological survival at hospital discharge we identified verylow-certainty evidence (down-graded for risk of bias and imprecision) from five observational studies. 17À21 19 (Fig. 2).…”

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

“…For the critical outcomes of survival with favourable neurological outcome 29 , 30 , 31 and survival to hospital discharge 29 , 30 , 31 , 32 , 33 , 34 and the important outcomes of survival to hospital admission, 29 , 30 , 32 , 33 ROSC, 29 , 30 , 31 , 32 , 33 , 34 , 35 and termination of VF, 31 , 34 , 35 we identified only observational studies. The overall certainty of evidence was rated as very low for all outcomes, primarily because of a very serious risk of bias.…”