Double Sequential Defibrillation: An Update of Contemporary Defibrillation Strategies for Pulseless Ventricular Tachycardia and Fibrillation

TL;DR

This paper reviews a clinical trial on double sequential defibrillation for treating cardiac arrest and concludes it should not be included in current resuscitation guidelines.

Contribution

The paper provides a critical analysis of DSED's effectiveness and recommends against its inclusion in resuscitation protocols.

Findings

DSED did not show significant improvement in resuscitation outcomes for refractory ventricular fibrillation.

The editorial recommends against using DSED in contemporary resuscitation guidelines.

Updated defibrillation outcomes highlight the importance of pad placement and defibrillation vectors.

Abstract

In a clinical trial, the role of double sequential external defibrillation (DSED) in treating refractory ventricular fibrillation (VF) was evaluated. Many Americans suffer from sudden cardiac arrest daily, and resuscitation rates are low especially in patients with refractory ventricular tachycardia (VT)/fibrillation. This trial was a prehospital resuscitation trial exploring methods to improve meaningful survival in this difficult patient cohort. I applaud the efforts of this trial, along with all of those involved in research and education, in trying to improve outcomes by improving recognition and bystander CPR, reducing delays in EMS activation, initiating CPR and the first delivery of a defibrillation shock, and adjusting pad placement to more successfully defibrillate the patient. In this editorial, I discuss in detail the outcomes of this landmark clinical trial, along with supplemental information submitted by the primary authors. Also, I review the updated defibrillation outcomes by defibrillator pad placement and defibrillation vectors. Finally, I give my recommendation to not include DSED in contemporary resuscitation guidelines and my rationale and justification for my recommendation.