title: Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest.
abstract: Survival from out of hospital cardiac arrest (OHCA) is highest in victims with shockable rhythms when early CPR and rapid defibrillation are provided. However, a subset of individuals present with ventricular fibrillation (VF) that does not respond to defibrillation (refractory VF). One intervention that may be a possible option in refractory VF is double sequential external defibrillation (DSD). The objective of this case series was to describe the outcome of prehospital victims with refractory VF treated with DSD in the out-of-hospital setting.
  
  
  
  This evaluation is a retrospective chart review of VF patients treated with DSD in the prehospital setting from August 1st, 2010 through June 30th, 2014. Patients were excluded if less than 17 years of age. The outcomes we evaluated were the number of patients with return of spontaneous circulation, conversion from VF, survival-to-hospital discharge, and Cerebral Performance Category score.
  
  
  
  Total of 2428 OHCA events were reviewed with twelve patients treated with DSD. Median DSD and prehospital resuscitation times were 27min (IQR 22-33) and 32 (IQR 24-38), respectively. Of the 12 patients treated, return of spontaneous circulation was achieved in three patients, nine patients were converted out of ventricular fibrillation, three patients survived to hospital discharge, and two patients (2/12, 17%) were discharged with Cerebral Performance Category scores of 1 (good cerebral performance).
  
  
  
  Double sequential defibrillation may be another tool to improve neurologically intact survival from OHCA. Further studies are needed to demonstrate direct benefits to patient outcomes.
authors: City of Columbus, Division of Fire, Columbus, OH, United States; Ohio Health Doctors Hospital, Columbus, OH, United States.
authors: Eric
authors: E
authors: Cortez
authors: Center for EMS, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
authors: William
authors: W
authors: Krebs
authors: City of Columbus, Division of Fire, Columbus, OH, United States.
authors: James
authors: J
authors: Davis
authors: City of Columbus, Division of Fire, Columbus, OH, United States; Center for EMS, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
authors: David P
authors: DP
authors: Keseg
authors: Center for EMS, The Ohio State University Wexner Medical Center, Columbus, OH, United States. Electronic address: ashish.panchal@osumc.edu.
authors: Ashish R
authors: AR
authors: Panchal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D047548:Defibrillators / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000379:methods*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000401:mortality / Q000628:therapy*
keywords: Cardiac arrest; Defibrillation; Double sequential defibrillation; Out of hospital cardiac arrest; Refractory; Ventricular fibrillation