Background: In the United States 424,000 out of hospital cardiac arrests occur per year with a 10.4% overall survival rate.1 Refractory Ventricular Fibrillation (RVF) is a complication of cardiac arrest and has varying definitions in the literature but is commonly defined as ventricular fibrillation that does not respond to, or resists, three or more defibrillation attempts.2,3Although the estimated incidence of refractory ventricular fibrillation is 0.5-0.6 per 100,000 of the population, some authors report that 10-25% of cardiac arrest cases could develop RVF or recurrent VF.3-5 Patients who experience RVF during their cardiac arrest have a mortality of up to 97%.6,7 Several case reports have shown success with excellent neurologic outcomes in terminating RVF using dual defibrillation after failure of traditional Advance Cardiac Life Support (ACLS) measures.8-12 It is important to note and distinguish that dual defibrillation can either be simultaneous or sequential depending on the duration of the defibrillation potential as well as the intershock interval between the two defibrillator shocks.9-13 The terms “sequential” and “simultaneous” are often used interchangably due to the lack of accurately measuring pulse intervals when performing dual defibrillation in the actual clinical environment. The authors of this review utilize the term dual sequential defibrillation (DSD). They present a case of RVF in a patient with cardiac arrest, on whom DSD was successful in reversion to sinus rhythm and provide a thorough review of similar cases in the literature.

Background: In cardiac arrest, high quality, uninterrupted CPR is essential to help improve survival rates. In theory, mechanical CPR should provide CPR at a standard depth and rate for prolonged periods without a decline in quality, which should help improve survival and survival with good neurologic outcomes. There are many types of mechanical chest compression devices but the two main technologies can be generalized as piston devices and load-distributing bands. The piston driven devices work by compressing on the chest in an up and down type of motion, similar to how we do manual CPR. The load distributing bands wrap all the way around the chest and shorten and lengthen which provides more of a rhythmic type of chest compression. No individual trials have ever shown superiority on clinically important outcomes for adult patients with OHCA, regardless of device.

Background: Focused use of ultrasound in resuscitation of patients with shock and cardiac arrest has become increasingly embraced in both the emergency department (ED) as well as in the prehospital setting. Application of ultrasound, particularly of echocardiography, has the potential to identify treatable causes of shock and arrest, identify shockable rhythms and identify the presence of mechanical activity. All of these can affect management decisions and, potentially effect outcomes. Recent studies have led to concerns that integration of point of care ultrasound (POCUS) in cardiac arrest increases pauses in compressions. Thus, it is important to establish what POCUS adds to shock and arrest management.

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