Abstract
Introduction
Cardiac arrests associated with shockable rhythms such as ventricular fibrillation
or pulseless VT (VF/pVT) are associated with improved outcomes from cardiac arrest.
The more defibrillation attempts required to terminate VF/pVT, the lower the survival.
Double sequential defibrillation (DSD) has been used for refractory VF/pVT cardiac
arrest despite limited evidence examining this practice. We performed a systematic
review to summarize the evidence related to the use of DSD during cardiac arrest.
Methods
This review was performed according to PRISMA and registered on PROSPERO (ID: CRD42020152575).
We searched Embase, Pubmed, and the Cochrane library from inception to 28 February
2020. We included adult patients with VF/pVT in any setting. We excluded case studies,
case series with less than five patients, conference abstracts, simulation studies,
and protocols for clinical trials. We predefined our outcomes of interest as neurological
outcome, survival to hospital discharge, survival to hospital admission, return of
spontaneous circulation (ROSC), and termination of VF/pVT. Risk of bias was examined
using ROBINS-I or ROB-2 and certainty of studies were reported according to GRADE
methodology.
Results
Overall, 314 studies were identified during the initial search. One hundred and thirty
studies were screened during title and abstract stage and 10 studies underwent full
manuscript screening, nine included in the final analysis. Included studies were cohort
studies (n = 4), case series (n = 3), case-control study (n = 1) and a prospective pilot clinical trial (n−1). All studies were considered to have serious or critical risk of bias and no meta-analysis
was performed. Overall, we did not find any differences in terms of neurological outcome,
survival to hospital discharge, survival to hospital admission, ROSC, or termination
of VF/pVT between DSD and a standard defibrillation strategy.
Conclusion
The use of double sequential defibrillation was not associated with improved outcomes
from out-of-hospital cardiac arrest, however the current literature has a number of
limitations to interpretation. Further high-quality evidence is needed to answer this
important question.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Improving temporal trends in survival and neurological outcomes after out-of-hospital cardiac arrest.Circ Cardiovasc Qual Outcomes. 2018; 11: e003561
- The effect of time to defibrillation and targeted temperature management on functional survival after out-of-hospital cardiac arrest.Resuscitation. 2014; 85: 1623-1628
- American Heart Association National Registry of Cardiopulmonary Resuscitation I. Delayed time to defibrillation after in-hospital cardiac arrest.N Engl J Med. 2008; 358: 9-17
- Incidence and outcomes of out-of-hospital cardiac arrest with shock-resistant ventricular fibrillation: data from a large population-based cohort.Resuscitation. 2010; 81: 956-961
- Recurrent ventricular fibrillation during advanced life support care of patients with prehospital cardiac arrest.Resuscitation. 2008; 78: 252-257
- The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest.Scand J Trauma Resusc Emerg Med. 2015; 23: 34
- Current concepts for selecting the location, size and shape of defibrillation electrodes.Pacing Clin Electrophysiol. 1991; 14: 227-240
- Systematic evaluation of the determinants of defibrillation efficacy.Heart Rhythm. 2005; 2: 36-41
- Double sequential external defibrillation for refractory ventricular fibrillation out-of-hospital cardiac arrest: a systematic review and meta-analysis.Resuscitation. 2019; 135: 124-129
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6: e1000097
- Part 4: advanced life support: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.Circulation. 2015; 132: S84-S145
- ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.BMJ. 2016; 355: i4919
- RoB 2: a revised tool for assessing risk of bias in randomised trials.BMJ. 2019; 366: l4898
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.BMJ. 2008; 336: 924-926
- R: a language and environment for statistical computing [computer program].R Foundation for Statistical Computing, Vienna, Austria2019
- How to perform a meta-analysis with R: a practical tutorial.Evid Based Mental Health. 2019;
- Double sequential external defibrillation in out-of-hospital refractory ventricular fibrillation: a report of ten cases.Prehosp Emerg Care. 2015; 19: 126-130
- Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest.Resuscitation. 2016; 108: 82-86
- Prehospital double sequential defibrillation: a matched case–control study.Acad Emerg Med. 2019; 26: 994-1001
- A case series of double sequence defibrillation.Prehosp Emerg Care. 2016; 20: 550-553
- Dual defibrillation in out-of-hospital cardiac arrest: a retrospective cohort analysis.Resuscitation. 2016; 106: 14-17
- Effectiveness of prehospital dual sequential defibrillation for refractory ventricular fibrillation and ventricular tachycardia cardiac arrest.Prehosp Emerg Care. 2019; 23: 597-602
- Double sequential defibrillation therapy for out-of-hospital cardiac arrests: the London experience.Resuscitation. 2017; 117: 97-101
- Double sequential external defibrillation for refractory ventricular fibrillation: the DOSE VF pilot randomized controlled trial.Resuscitation. 2020;
- The impact of double sequential external defibrillation on termination of refractory ventricular fibrillation during out-of-hospital cardiac arrest.Resuscitation. 2019; 139: 275-281
- Resuscitation time bias – a unique challenge for observational cardiac arrest research.Resuscitation. 2018; 125: 79-82
- External defibrillator damage associated with attempted synchronized dual-dose cardioversion.Ann Emerg Med. 2018; 71: 109-112
Article info
Publication history
Published online: June 16, 2020
Accepted:
June 9,
2020
Received in revised form:
June 5,
2020
Received:
April 29,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V.
