Double Defibrillation for Refractory In- and Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Miraglia, Dennis; Miguel, Lourdes A.; Alonso, Wilfredo

doi:10.1016/j.jemermed.2020.06.024

Cited by 3 publications

(4 citation statements)

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“…Refractory VF (RVF) is identified as a VF that does not resolve after three or five consecutive defibrillation attempts in addition to antiarrhythmic medications (Emmerson et al, 2017;Leacock, 2014;Miraglia et al, 2020). With every defibrillation attempt, the success rate of terminating the VF decreases, and the mortality rate increases (Eifling et al, 2011;Koster et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

“…Most VF patients respond to treatment; however, there is a subset of patients who do not respond to either defibrillation or antiarrhythmic medications (Eifling et al, 2011 ; Sakai et al, 2010 ). Refractory VF (RVF) is identified as a VF that does not resolve after three or five consecutive defibrillation attempts in addition to antiarrhythmic medications (Emmerson et al, 2017 ; Leacock, 2014 ; Miraglia et al, 2020 ). With every defibrillation attempt, the success rate of terminating the VF decreases, and the mortality rate increases (Eifling et al, 2011 ; Koster et al, 2008 ).…”

Section: Introductionmentioning

confidence: 99%

“…The exact mechanism by which the DSED terminates the RVT is unknown. However, its efficacy is reasoned to different theories, including higher energy delivery to overcome the increased defibrillatory threshold, exposing more myocytes to the shock, and lowering the defibrillation threshold (Miraglia et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…With the lack of randomized control trials (RCTs) to evaluate the efficacy of the new defibrillation techniques and the available evidence is mainly based on observational data (Deakin et al, 2020 ; Delorenzo et al, 2019 ; Miraglia et al, 2020 ), there is a need to explore their efficacy compared to SD in the OHCA. After the publication of the first RCT comparing DSED, VCT, and SD, we thought of conducting this network meta‐analysis to evaluate the comparative efficacy of DSED, VCD, and SD in RVT in OHCA.…”

Section: Introductionmentioning

confidence: 99%

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Defibrillation strategies for refractory ventricular fibrillation out‐of‐hospital cardiac arrest: A systematic review and network meta‐analysis

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et al. 2023

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Background and ObjectiveDouble sequential external defibrillation (DSED) and vector‐change defibrillation (VCD) have been suggested to enhance clinical outcomes for patients with ventricular fibrillation (VF) refractory of standard defibrillation (SD). Therefore, this network meta‐analysis aims to evaluate the comparative efficacy of DSED, VCD, and SD for refractory VF.MethodsA systematic review and network meta‐analysis synthesizing randomized controlled trials (RCTs) and comparative observational studies retrieved from PubMed, EMBASE, WOS, SCOPUS, and Cochrane through November 15th, 2022. R software netmeta and netrank package (R version 4.2.0) and meta‐insight software were used to pool dichotomous outcomes using odds ratio (OR) presented with the corresponding confidence interval (CI). Our protocol was prospectively published in PROSPERO with ID: CRD42022378533.ResultsWe included seven studies with a total of 1632 participants. DSED was similar to SD in survival to hospital discharge (OR: 1.14 with 95% CI [0.55, 2.83]), favorable neurological outcome (modified Rankin scale ≤2 or cerebral performance category ≤2) (OR: 1.35 with 95% CI [0.46, 3.99]), and return of spontaneous circulation (ROSC) (OR: 0.81 with 95% CI [0.43; 1.5]). In addition, VCD was similar to SD in survival to hospital discharge (OR: 1.12 with 95% CI [0.27, 4.57]), favorable neurological outcome (OR: 1.01 with 95% CI [0.18, 5.75]), and ROSC (OR: 0.88 with 95% CI [0.24; 3.15]).ConclusionDouble sequential external defibrillation and VCD were not associated with enhanced outcomes in patients with refractory VF out‐of‐hospital cardiac arrest, compared to SD. However, the current evidence is still inconclusive, warranting further large‐scale RCTs.

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