Double Sequence External Defibrillation (DSED) is an advanced resuscitation technique utilized in cases of refractory ventricular fibrillation (RVF), particularly in out-of-hospital cardiac arrest (OHCA) scenarios. This method involves the application of simultaneous electrical shocks from two defibrillators, which can potentially enhance the chances of restoring normal heart rhythm compared to standard defibrillation techniques. The rationale behind DSED is that the dual shocks create two distinct electrical vectors, which may depolarize a larger area of the myocardium than a single shock, thereby increasing the likelihood of successful defibrillation (Kim et al., 2020; Cheskes et al., 2023).
Research indicates that DSED can lead to improved outcomes for patients experiencing RVF. For instance, studies have shown that patients treated with DSED exhibited higher rates of return of spontaneous circulation (ROSC) and better neurological recovery compared to those receiving conventional defibrillation (Kim et al., 2020; Li et al., 2022; Mapp et al., 2019). A systematic review and meta-analysis further supports these findings, suggesting that DSED may offer significant advantages over standard defibrillation in terms of survival rates and neurological outcomes (Li et al., 2022). Additionally, a matched case-control study indicated that prehospital DSED is associated with improved survival rates to hospital admission for patients with RVF or pulseless ventricular tachycardia (Mapp et al., 2019).
Despite its potential benefits, the implementation of DSED is not without challenges. Concerns regarding the safety and efficacy of using two defibrillators simultaneously have been raised, particularly regarding the risk of equipment damage during the procedure (Drennan et al., 2022). Furthermore, the technique requires careful coordination and timing, which can complicate its application in emergency situations (Cheskes et al., 2023; Mapp et al., 2019). Nevertheless, the growing body of evidence supporting DSED suggests that it may be a valuable addition to the resuscitation toolkit for managing RVF in critical scenarios, particularly when conventional methods fail (Cheskes et al., 2023; Li et al., 2022; Mapp et al., 2019).
In summary, Double Sequence External Defibrillation represents a promising approach to treating refractory ventricular fibrillation, with evidence suggesting improved outcomes compared to standard defibrillation. However, further research is necessary to address safety concerns and optimize its application in emergency medical settings.
References:
- Cheskes, S., McLeod, S., & Scales, D. (2023). Double sequential external defibrillation for refractory ventricular fibrillation. Intensive Care Medicine, 49(4), 455-457.
https://doi.org/10.1007/s00134-023-06993-1
- Drennan, I., Seidler, D., & Cheskes, S. (2022). A survey of the incidence of defibrillator damage during double sequential external defibrillation for refractory ventricular fibrillation. Resuscitation Plus, 11, 100287.
https://doi.org/10.1016/j.resplu.2022.100287
- Kim, H., Lee, K., Jo, Y., Lee, J., Kim, Y., Kim, J., … & Oh, Y. (2020). Refractory ventricular fibrillation treated with double simultaneous defibrillation: pilot study. Emergency Medicine International, 2020, 1-6.
https://doi.org/10.1155/2020/5470912
- Li, Y., He, X., Li, Z., Li, D., Yuan, X., & Yang, J. (2022). Double sequential external defibrillation versus standard defibrillation in refractory ventricular fibrillation: a systematic review and meta-analysis. Frontiers in Cardiovascular Medicine, 9.
https://doi.org/10.3389/fcvm.2022.1017935
- Mapp, J., Hans, A., Darrington, A., Ross, E., Ho, C., Miramontes, D., … & Wampler, D. (2019). Prehospital double sequential defibrillation: a matched case–control study. Academic Emergency Medicine, 26(9), 994-1001.
https://doi.org/10.1111/acem.13672