Until such guidelines are established, physicians should take this treatment into consideration when standard ACLS measures have failed to successfully terminate refractory ventricular fibrillation.Ĭardioversion defibrillation dual sequential refractory ventricular fibrillation.Ĭopyright © 2016 Elsevier Inc. Previously used in the electrophysiology suite, this technique has recently been used in the emergency department and prehospital setting for out-of-hospital cardiac. The patient is converted to a normal sinus rhythm and there are no. The double sequential defibrillation is successful. Further investigation on cardiac resuscitation should be conducted to standardize the dual sequential defibrillation delivery procedure. Dual sequential external defibrillation (DSED) is the process of near simultaneous discharge of two defibrillators with differing pad placement to terminate refractory arrhythmias. Dual Sequential Defibrillation in Shock Refractory VF Resuscitation. Figure 2: Placement of AED pads during double sequential defibrillation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case shows that dual sequential defibrillation may be a successful method for terminating refractory ventricular fibrillation. When attempting defibrillation, the BIPHASIC trial showed that increasing the amount of energy corresponds to a better chance of defibrillation. The patient had immediate return of spontaneous circulation, underwent cardiac catheterization, and was discharged home 1 week later. Dual-sequential defibrillation is a novel intervention for refractory ventricular fibrillation that has a small but growing body of evidence. After four unsuccessful defibrillation attempts, a second defibrillator was placed on the patient, and the two were activated almost simultaneously. VF ventricular fibrillation ROSC return of spontaneous circulation DSED double sequential external defibrillation. While in the emergency department, the patient developed ventricular fibrillation, and ACLS was initiated. The patient's initial work-up, including an electrocardiogram and cardiac troponin, did not show evidence of acute ischemia, and she was admitted to the observation unit for further evaluation. This pilot study sought to determine the feasibility and safety of a full scale RCT comparing these. Vector change defibrillation switching pads from the anterior-lateral to anterior-posterior position. In this case, two defibrillators were used to deliver a greater than normal energy waveform over an extended time interval to return a patient to a normal sinus rhythm.Ī 56-year-old woman presented to the emergency department with complaints of chest pain, nausea, and vomiting. Double sequential external defibrillation 2 rapid sequential shocks given via 2 defibrillators with pads attached in 2 different planes. When treatments defined by the ACLS guidelines are unsuccessful in terminating a lethal dysrhythmia, the use of alternative strategies may prove useful. Current guidelines for the treatment of adult patients in cardiac arrest are supplied by the American Heart Association through basic life support and advanced cardiovascular life support (ACLS) provider courses.
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