Double simultaneous external defibrillation

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Overview

In patients suffering from non-traumatic cardiac arrest who exhibit ventricular fibrillation refractory to standard defibrillation, two simultaneous shocks may be considered. This is termed double sequential external defibrillation (DSED) and has been shown to have some effect in terminating VF[1][2], though existing data on neurologic outcomes conflict. Several large EMS systems currently use DSED in their standing medical orders[3].

Indications

  • Cardiopulmonary arrest
  • Refractory ventricular fibrillation

Contraindications

  • Spontaneous circulation

Equipment Needed

  • Two monitors capable of manual defibrillation (both biphasic or both monophasic)
  • Pre-hospital or hospital provider credentialed to perform defibrillation
  • Two sets of defibrillation pads

Procedure

1. Apply second set of defibrillation pads (configurations vary) 2. Charge both monitors to the desired energy level 3. After ensuring providers are not in contact with the patient, simultaneously activate the defibrillation/shock button on each monitor 4. Resume chest compressions

Complications

  • Ineffective deliver of electrical defibrillation due to overlapping or improperly applied pads
  • Inability to apply two sets of defibrillation pads without overlapping

See Also

See Also

References

  1. Hoch DH, et al. Double sequential external shocks for refractory ventricular fibrillation. J Am Coll Cardiol. 1994; 23(5):1141-5.
  2. Cabanas JG, et al. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases. Prehosp Emerg Care. 2015; 19(1):126-130.
  3. Cortez E et al. Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest. Resuscitation 2016; 108:82-6.