Double sequential external defibrillation (DSED) is a novel intervention which has shown potential in the management of refractory ventricular fibrillation (VF). This review aims to identify the literature surrounding the use of DSED in out-of-hospital refractory VF and assess whether this intervention improves survival outcomes.
The databases Ovid Medline, EMBASE, CINAHL, SCOPUS and the Cochrane Library were searched from their commencement to January 29th 2018. Google (scholar) was also searched for grey literature. We combined MeSH terms and text words for DSED in refractory VF and included studies that used an interventional or observational design. Study quality was assessed using the Newcastle-Ottawa Scale. A random effects model using the DerSimonian & Laird method was used to calculate pooled ORs and 95% CIs.
The search yielded 5351 unique records, of which two retrospective studies met the eligibility criteria. No randomised controlled trials were identified. The pooled population included 499 patients of which 19% (n = 95) received DSED and 81% (n = 404) were managed with standard resuscitation protocols. Confirmation of DSED was self-reported by paramedics. Neither study adjusted for confounding factors or baseline characteristics across the study groups. The definition of refractory VF and the protocol for DSED use differed across studies. Over half of cases were witnessed cardiac arrests (58.7%, n = 293) and bystander CPR was initiated in 53.3% (n = 266) of cases. In the meta-analysis, DSED had no effect on survival to hospital discharge (OR 0.69, 95% CI: 0.30, 1.60), event survival (OR 0.98, CI: 0.59, 1.62) or ROSC (OR 0.86, 95% CI: 0.49–1.48).
The effectiveness of DSED remains unclear. Further well-designed prospective studies are needed to determine whether DSED has a role in the treatment of refractory VF.
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Published online: October 26, 2018
Accepted: October 25, 2018
Received in revised form: June 15, 2018
Received: April 26, 2018
© 2018 Elsevier B.V. All rights reserved.
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- Importance of the distinction between recurrent and shock-resistant ventricular fibrillation: Call for a uniform definition of refractory VFResuscitationVol. 138
- PreviewWith great interest we read the article on double sequential defibrillation (DSD) for refractory ventricular fibrillation (VF) during out-of-hospital cardiac arrest (OHCA).1 The authors provide an extensive overview of the available evidence on DSD, a treatment strategy aimed to improve the outcome of patients with refractory VF. In this study, another important issue is highlighted that goes beyond the scope of DSD alone, i.e. the lack of a universal definition of a patient with refractory VF.