Double sequential defibrillation3/26/2023 ![]() ![]() ![]() The case series by Cabanas et al did not show improved outcomes in 10 patients treated with DSD, but did report successful defibrillation in most. ![]() Initial case reports of treating RVF with DSD showed some promise. Each set of pads is attached to a different manual defibrillator, and both defibrillators are discharged at same time.Īs your review of the pertinent literature describes, experience with using DSD in routine clinical care is low. The procedure is exactly as you describe – essentially, the provider places two sets of defibrillation pads in the classic anterior-lateral position as well as in the anterior-posterior midline position. DSD provides an attractive option for the treatment of RVF. While rare, the case you describe is very real and can make a prehospital provider or emergency physician feel almost hopeless – you are trying all the right things (defibrillation, anti-dysrhythmics) to treat your patient in refractory ventricular fibrillation (RVF), and yet the lethal dysrhythmia persists. Very nice overview of dual sequential defibrillation (DSD) – also called “double sequence defibrillation,” “double simultaneous defibrillation,” “dual defibrillation,” and “double sequential external defibrillation” in the literature (let’s just call it “DSD”). Apply pads as indicated (above), or watch a quick video (below) on the procedure, courtesy of EM:RAP HD. If you have a patient in refractory ventricular fibrillation, you may consider using double sequential defibrillation with both machines charged to 360 J for a total of 720 J. Moreover, these patients did not suffer myocardial damage from the increased voltages. Ī study from Mexico showed dual sequential defibrillation with 720 J to be 90% (19/21) successful in patients with atrial fibrillation refractory to normal voltages. Ī retrospective study published in the Journal of American Cardiology in 1994 found that of approximately 3000 patients in ventricular fibrillation, 5 had refractory ventricular fibrillation and in all 5 cases the Vfib was terminated by double sequential defibrillation. However, none of these patients survived until discharge. But what does the literature say?Ī retrospective study of 10 cases published in Prehospital Emergency Care showed that 70% of cases refractory VF were terminated with double sequential defibrillation. While there is a theoretical risk of R on T phenomena, the patient is mostly dead at this point. ![]() They are wired such that electricity cannot travel back up the wires. The theoretical damage to the myocardium from sustained VF is more detrimental than 720 joules. Here's what Darren Braude and Brent Myers as featured on EM RAP have to say : It is safe. Should you prepare two defibrillators for double sequential defibrillation? Is this a real thing? You take the radio call that EMS is en route with a patient in cardiac arrest with refractory VF. At each pulse/rhythm check the patient remains in ventricular fibrillation that is refractory to multiple attempts at defibrillation despite having received an anti-dysrhythmic medication. They perform 5 rounds of advanced cardiac life support (ACLS) in the field. Bystander cardiopulmonary resuscitation (CPR) is initiated immediately. EMS arrives and finds the patient to be in ventricular fibrillation (VF). Dual sequential defibrillation (DSD) has garnered some press in the podcast world and was recently featured on EM RAP on the February episode.Ī 50-year-old male collapses at work and is found to be pulseless. What is better than shocking someone back into rhythm? Shocking them with twice the electricity. ![]()
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |