Dual Sequential Defibrillation - Earlier Is Better?

Written by Clay Smith

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Dual sequential defibrillation (DSD) was ineffective overall in refractory ventricular fibrillation (v-fib) in terminating v-fib to return of spontaneous circulation (ROSC). The subgroup in which DSD was performed earlier (shocks 4-8) had improved ROSC.

Why does this matter?
JF has written about DSD in depth in the past here. A subsequent study showed it was ineffective. To keep the energy from one machine from damaging another, you will want to read this.

I can’t think of anything shocking to say here.
This was a retrospective review of patients with v-fib refractory to three sequential standard defibrillation attempts and compared those who had additional standard attempts to those who underwent DSD. There were just 252 patients who met criteria for refractory v-fib; 80% got standard defib, 20% DSD. Overall, ROSC was the same in both: 21.4% standard vs. 17.6% DSD (RR: 0.8; 95%CI 0.4-1.6). In the subgroup that received shocks earlier in the course of refractory v-fib (shocks four through eight), DSD had an advantage over standard: 15.7% vs. 5.4% (RR: 2.9; 95%CI: 1.4-5.9). This was accomplished with one DSD shock 67% of the time. Keep in mind, this says nothing about the most important outcome, survival with good neurologic outcome. I think the jury is still out on DSD.

Source
The impact of double sequential external defibrillation on termination of refractory ventricular fibrillation during out-of-hospital cardiac arrest. Resuscitation. 2019 Jun;139:275-281. doi: 10.1016/j.resuscitation.2019.04.038. Epub 2019 May 3.

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Reviewed by Thomas Davis

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