Double sequential external shocks for refractory ventricular fibrillation

Abstract

This report stresses the importance of an additional defibrillator being readily available during electrophysiologic testing. This technique of rapid, double sequential external shocks may have general applicability, providing a simple and potentially lifesaving approach to refractory ventricular fibrillation.

Dual defibrillation in out-of-hospital cardiac arrest: A retrospective cohort analysis

“…We utilize the dual defibrillation (DD) technique, where the operator delivers nearly simultaneous defibrillations from two separate devices. Multiple techniques for DSD have been described: small 1-2 s delays between the delivery of sequential shocks, 8 precisely synchronized shocks with small overlaps, 9,10 and simultaneous delivery from two devices by a single individual. 11 The mechanism for DSD's hypothesized clinical benefit focuses primarily on overcoming the defibrillation threshold.…”

“…7 Due to its rarity and lack of a standard definition, there are no currently established best practices for this difficult to treat condition. Double sequential defibrillation (DSD) is postulated to be a solution to the dilemma of recurrent/refractory VF and pulseless VT. 8 In DSD, the "double" refers to the use of two separate defibrillators on the same patient; "sequential" refers to the administration of nearly simultaneous defibrillations from both devices. In the absence of electronically connected and synchronized defibrillation devices, true DSD is not possible in our prehospital system.…”

“…9,10,17 Hoch et al reported a small observational study attesting to the safety and efficacy of DSD's in the setting of refractory VF and pulseless VT during routine electrophysiology testing. 8 Double sequential defibrillation continues to be used sporadically by electrophysiologists to treat refractory VF. 12 Emergency Medical Services (EMS) physicians struggle with the decision whether or not to transport patients with refractory and recurrent VF.…”

“…15,16 The last leading theory for DSD efficacy is that the therapy changes the vector of the therapy and the shock is given over a longer duration. 8 DSD was first developed and tested in canine models of refractory VF. 9,10,17 Hoch et al reported a small observational study attesting to the safety and efficacy of DSD's in the setting of refractory VF and pulseless VT during routine electrophysiology testing.…”

Simultaneous Double External DC Shock Technique for Refractory Atrial Fibrillation in Concomitant Heart Disease

“…The use of double external DC shocks was first described in 1994 by Hoch, et al 19) for refractory ventricular fibrillation. Bjerregarrd and coworkers.…”