The impact of double sequential external defibrillation on termination of refractory ventricular fibrillation during out-of-hospital cardiac arrest

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.…”

“…Lastly, in 2019, another retrospective study on DSD in OHCA was published by Cheskes et al While the study did not evaluate survival or functional outcomes to hospital discharge, it did find that there is an association between improved rates of refractory VF termination and ROSC, when early DSD was considered for refractory VF (defibrillation attempt 4-8) in the DSD group vs. the SD group (15.7% vs. 5.4%; RR: 2.9; 95% CI: 1.4-5.9). Nevertheless, when the overall effect of early and late defibrillation attempts where combined, VF termination and ROSC were similar amongst the DSD group vs. the SD group (17.6% vs. 21.4%; RR: 0.8; 95% CI: 0.4-1.6) [15]. DSD is not currently included in AHA 2017 guidelines for the management of patients with ventricular arrhythmias (VA) nor specific recommendations have been established for the treatment of refractory VF [28].…”

“…Overall, refractory VF was terminated in 7 out 10 patients; in those who were terminated (70 %), ROSC was achieved only in 30.0% of them; in the end there were no survival to hospital discharges [10]. Recent studies support that the use of early DSD may terminate refractory VF and maintain sustained ROSC to hospital admission, but no increased benefit in survival or good neurological outcome (CPC 1 and 2) at the time of discharge when compared with the best current standard of care [13,14,15]. The first large study on DSD in OHCA was published in 2016 by Ross et al This observational retrospective case-control study evaluated neurologically intact survival to discharge as a primary outcome in 50 patients who received DSD vs. 299 who received biphasic SD at 200 J; not statistically significant (p = 0.32) was found between the two groups.…”

“…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.…”

Successful resuscitation of refractory ventricular fibrillation with double sequence defibrillation

“…To date, all existing studies have been conducted on OHCA, most of which were performed by emergency medical technicians at the pre-hospital level [4][5][6]. There are no current reports of DSD to terminate refractory VF in IHCA.…”