Double sequential external defibrillation for refractory ventricular fibrillation out-of-hospital cardiac arrest: A systematic review and meta-analysis

  • Ashleigh Delorenzo
    Affiliations
    Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
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  • Ziad Nehme
    Correspondence
    Corresponding author at: Centre for Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster, Victoria, 3108, Australia.
    Affiliations
    Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia

    Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
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  • James Yates
    Affiliations
    Great Western Air Ambulance, Bristol, United Kingdom

    South Western Ambulance Service NHS Trust, United Kingdom
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  • Stephen Bernard
    Affiliations
    Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia

    The Alfred Hospital, Victoria, Australia
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  • Karen Smith
    Affiliations
    Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia

    Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia

    Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
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      Abstract

      Background

      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.

      Methods

      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.

      Results

      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).

      Conclusion

      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.

      Keywords

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