![]() The post-shock rhythm analysis revealed a brief period of systole into sinus bradycardia with the ROSC. The patient then was noted to be back in ventricular fibrillation, and dual sequential defibrillation was again performed. The post-shock rhythm revealed pulseless electrical activity (PEA) on the monitor, and CPR was resumed along with the seventh dose of epinephrine. Both the engine and medic defibrillators were used to deliver 360J, each nearly simultaneously. The patient had a second set of pads placed in the anteroapical position. Over the course of 26 minutes five subsequent standard defibrillations were administered unsuccessfully.Īt this point EMS contacted online medical control, and DSD was ordered. A supraglottic airway device was placed for ventilations and amiodarone 300mg was given. Intraosseous access was established and epinephrine was administered. The patient was found to be in VF and defibrillated at 200 joules (J) unsuccessfully. Emergency medical services (EMS) arrived with a six-minute response time. ( Image)Ī 58-year-old male with a history of hypertension and cardiac stents two years prior had just arrived at a Saturday morning prayer breakfast at church when he suddenly went unresponsive and was found to be pulseless and apneic by bystanders. 4 When using DSD, two sets of pads are placed in the anteroapical and anteroposterior positions and deliver a shock nearly simultaneously. DSD has been used safely in electrophysiology labs for quite some time. RVF is typically defined as persistent VF following three to five unsuccessful shocks. We report on a case where double sequence defibrillation (DSD) was used to treat refractory ventricular fibrillation (RVF). ![]() 3 These moderately improved rates are likely attributed to high-quality bystander cardiopulmonary resuscitation (CPR) with increased emphasis on uninterrupted CPR with good technique. 2 Return of spontaneous circulation (ROSC) is rare in OHCA however, recently improved prehospital ROSC rates have been demonstrated. 1 Ventricular fibrillation (VF) is the most common rhythm after OHCA occurring in approximately 70% of cases. ![]() The global incidence of out-of-hospital cardiac arrest (OHCA) is 55 per 100,000 adults per year, and the average survival (to hospital discharge) is 7% in adults. ![]()
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