Double sequential defibrillation4/1/2023 With DSED, there is the additional influence of increased voltage and energy delivered by the second shock. Vector change defibrillation (VC) (the technique of switching defibrillation pads from anterior-lateral to anterior–posterior after failed defibrillation attempts) may result in a higher voltage gradient in the posterior part of the ventricle, where fibrillation is most likely to restart or fail to terminate after standard pad positions. 16 Considering the anatomical location of the left ventricle, a posterior structure, this region is furthest from the direct line between the standard anterolateral electrode pads. have demonstrated that when defibrillation fails to terminate VF, fibrillation resumes in the region of lowest voltage and current gradient in the myocardium. However, despite significant advances in resuscitation care, some patients remain in VF/VT after multiple standard defibrillation attempts, termed “refractory VF/VT”.2, 3 Survival to hospital discharge for patients who remain in refractory VF/VT is reported between 4.9% to 12.7%, much lower compared to survival in recurrent VF/VT which range from 21.4% to 29.3%.4, 5, 6, 7ĭouble sequential external defibrillation (DSED), the technique of providing rapid sequential defibrillatory shocks via two defibrillators with defibrillation pads placed in two different planes (usually anterior-lateral and anterior-posterior) has been studied for decades in the electrophysiology lab for patients in both refractory atrial fibrillation and refractory VF.8, 9, 10, 11, 12, 13, 14, 15 From an electrophysiology perspective, Ideker et al. 1 Patients presenting in VF/VT continue to represent the subgroup of patients for whom survival remains the greatest. DSD may not be beneficial in refractory VF/VT OHCA.Out-of-hospital cardiac arrest (OHCA) accounts for over 350,000 unexpected deaths each year in North America and nearly 100,000 of these are attributed to ventricular fibrillation or pulseless ventricular tachycardia (VF/VT). Defibrillation type was not associated with other OHCA endpoints. Conclusions: Compared with conventional defibrillation, DSD was associated with lower odds of prehospital ROSC. 32.3%, adjusted OR 0.52 ), or survival to hospital discharge (14.3% vs. There were no differences in survival to hospital admission (35.2% vs. ROSC was lower for DSD than standard defibrillation: 39.4% vs. Patient demographics and event characteristics were similar between both groups. Results: We included 310 patients in the analysis, 71 patients receiving DSD and 239 receiving conventional defibrillation. Using multivariable logistic regression, we evaluated the association between defibrillation type and OHCA outcomes, adjusting for patient demographics and event characteristics. Evaluated outcomes included return of spontaneous circulation (ROSC), survival to hospital admission, survival to 72 hours, and survival to hospital discharge. Physicians authorized subsequent DSD use by two separate defibrillators (PhysioControl LIFEPAK® 12/15) with pads placed anterior-lateral and anterior-posterior. We included all adult OHCA during 2013–2016 with ≥3 standard defibrillations. Methods: We used data from a large metropolitan fire-based EMS service. We evaluated the association of DSD with survival after refractory VF/VT OHCA. While associated with rescue shock success, the effect of DSD upon out-of-hospital cardiac arrest (OHCA) is unknown. Objective: Dual sequential defibrillation (DSD) - successive defibrillations with two defibrillators - offers a novel approach to refractory ventricular fibrillation (RVF) and tachycardia (VF/VT).
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