Download Dual Sequential Defibrillation - 2017 Indiana EMS Association

Dual Sequential Defibrillation
Andrew J. Bowman, MSN, RN, ACNP-BC, ACNP-C, TNS, CEN, CPEN, CTRN, CFRN, TCRN, CCRN-CMC, CVRN-I-BC, FACCN, FAEN, NRP
Background:
Out-of-hospital cardiac arrest (OHCA) occurs in the United States at a rate of nearly 300,000 individuals per year
with high mortality rate associated with this.
The majority of OHCA is due to cardiac etiology with the most common initial rhythm being ventricular fibrillation
(VF).
High-quality, limited interruption cardiopulmonary resuscitation (CPR) and early defibrillation are the hallmarks of
successful neurologic outcomes in OHCA.
For refractory, persistent (not recurrent/intermittent) VF, dual sequential defibrillation may be an option.
How do you perform dual simultaneous external defibrillation?
This procedure should only be used in refractory ventricular fibrillation after multiple attempts at defibrillation and
appropriate medications have been given.
Using a second defibrillator, you can place a second set of external defibrillation pads next to each other, but
ensure that the pads are not making contact with each other.
Charge both monitors (360J for monophasic and 200J for biphasic)
Ensure everyone is clear of the patient
Simultaneously press the shock button on both defibrillators
Immediately resume CPR
All of the above are acceptable ways to place the pads
Clinical Take Home Point:
Consider using high-energy, dual simultaneous defibrillation in patients with refractory VF only after high quality
CPR, several attempts at defibrillation, and appropriate medications have been given.
References:
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https://resusreview.com/2013/high-energy-defibrillation-for-incessant-ventricular-fibrillation/
Cabanas, J.G. (2015). Double sequential external defibrillation in out-of-hospital refractory ventricular fibrillation: A
report of ten cases. Prehospital Emergency Care. 19(1): 126-130.
Cohen, T.J. et al. (1993). Innovative emergency defibrillation methods for refractory ventricular fibrillation in a
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Cortez, E. et al. (2016). Use of double sequential external defibrillation for refractory ventricular fibrillation during
out-of-hospital cardiac arrest. Resuscitation. August 10, 2016.
Erich, J. (2011). Hold the coroner. Retrieved from http://www.emsworld.com/article/10318805/double-sequentialdefibrillation
Hoch, D.H., et al ( 1994). Double sequential defibrillation for refractory ventricular fibrillation. Journal of American
Cardiology. 23: 1141-45.
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gatheringofeagles.us/2016/2016presentations/Saturday/JuiDualSequentialDefib.pdf
Lawner, B. (2011). Non-stop V-fib? Double down on the defib. Retrieved from
https://umem.org/educational_pearls/1598/
Leacock, B. W. (2014). Double simultaneous defibrillators for refractory ventricular fibrillation. Journal of Emergency
Medicine. 46(4):472-4.
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Emergency Care. 19(4): 554-7.
Ross, E, et al (2016). Dual defibrillation in out-of-hospital cardiac arrest: A retrospective cohort analysis.
Resuscitation. Published online, June 21, 2016
Thomas, D. (2015). The one-two punch. Retrieved from http://www.scancrit.com/2015/07/07/one-two-punch
Zhang, Y. et al. (2002). Body weight is a predictor of biphasic shock success for low energy transthoracic
defibrillation. Resuscitation. 54(3):281-7.