Its use is controversial due to aspects related to the amount of energy delivered and the potential for harm. Early DSED had a higher success rate for arrhythmia termination and ROSC.They found that VF termination and ROSC were the same for the two groups.The question asked was if DSED was better than standard defibrillation in terminating ventricular fibrillation.Return of spontaneous circulation(ROSC)Ī retrospective study of DSED was recently published by Cheskes et al(7).The result was that DSED had no effect on either of:.They looked at out of hospital refractory ventricular fibrillation. Study 1(6) Delorenzo et al performed a meta analysis of the topic. Delivering biphasic waveforms may have the effect of greatly enhancing the energy delivered, or even cancelling it.Delivering dual shocks manually, may be equivalent to delivering two separate shocks, given the delay related to human reaction time(5).This process delivers high energy defibrillation, which in itself has been shown to promote ventricular arrhythmias(4).We are not sure if it actually works as most of the literature related to it is poor.The controversies related to this procedure Certainly before going to a procedure like this, that is not really backed in the literature, we need to ensure that we maximise what we are doing with standard defibrillation, which includes: The occurrence of resistant ventricular fibrillation is rare, as most cases terminate with a few standard shocks(3). It is these, that double sequential defibrillation is recommended for. Watch the video below for a discussion of cases.Įlectrical storm is different to refractory ventricular arrhythmias, which by definition do not terminate. This is usually a catecholamine driven response, thus removing catecholamines and even treating with a beta blocker may assist(2). Electrical storm is a state characterised by recurrent occurrences of unstable ventricular arrhythmias, over a short period of time. Resistant ventricular arrhythmias are different to electrical storm(1).
It is a controversial topic, with no robust studies. Double Sequential External Defibrillation(DSED) is a means of administering sequential shocks to terminate shock resistant ventricular fibrillation.
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