Dual Sequential Defibrillation (DSD)

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....Read More