Abstract Background. @entity2224 ( @entity2224 ) is considered the out-of-hospital @entity1167 (OOHCA) rhythm with the highest likelihood of neurologically intact survival. Unfortunately, there are occasions when @entity2224 does not respond to standard defibrillatory shocks. Current @entity299 ( @entity299 ) guidelines acknowledge that the data are insufficient in determining the optimal pad placement, waveform, or energy level that produce the best conversion rates from OOHCA with @entity2224 . Objective. To describe a technique of double sequential external defibrillation (DSED) for cases of @entity13832 ( @entity13832 ) during OOHCA resuscitation. Methods. A retrospective case series was performed in an urban/suburban @entity341 ( @entity341 ) system with advanced life support care and a population of 900,000. Included were all adult OOHCAs having @entity13832 during resuscitation efforts by @entity341 providers. @entity13832 was defined as persistent @entity2224 following at least 5 unsuccessful single shocks, @entity1425 administration, and a dose of antiarrhythmic medication. Once the @entity1 was in @entity13832 , @entity341 personnel applied a second set of pads and utilized a second defibrillator for single defibrillation with the new monitor/pad placement. If @entity2224 continued, @entity341 personnel then utilized the original and second monitor/defibrillator charged to maximum energy, and shocks were delivered from both machines simultaneously. Data were collected from electronic dispatch and @entity1 care reports for descriptive analysis. Results. From 01/07/2008 to 12/31/2010, a total of 10 @entity1 were treated with DSED. The median age was 76.5 (IQR: 65-82), with median resuscitation time of 51minutes (IQR: 45-62). The median number of single shocks was 6.5 (IQR: 6-11), with a median of 2 (IQR: 1-3) DSED shocks delivered. @entity2224 broke after DSED in 7 cases (70%). Only 3 @entity1 (30%) had ROSC in the field, and none survived to discharge. Conclusion. This case series demonstrates that DSED may be a feasible technique as part of an aggressive treatment plan for @entity13832 in the out-of-hospital setting. In this series, @entity13832 was terminated 70% of the time, but no @entity1 survived to discharge. Further research is needed to better understand the characteristics of and treatment strategies for @entity13832 .

Double Sequential External Defibrillation in Out-of-Hospital Refractory XXXX : A Report of Ten Cases.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1425 :: ('MESH:D004837', 'Chemical') :: ['epinephrine'] @entity13832 :: ('MESH:D000753', 'Disease') :: ['RVF', 'refractory VF'] @entity341 :: ('MESH:D004630', 'Disease') :: ['emergency medical services', 'EMS'] @entity2224 :: ('MESH:D014693', 'Disease') :: ['VF', 'Ventricular fibrillation'] @entity299 :: ('MESH:D006331', 'Disease') :: ['AHA', 'American Heart Association'] @entity1167 :: ('MESH:D006323', 'Disease') :: ['cardiac arrest']
@entity2224 :: (MESH:D014693,Disease) :: ['Ventricular Fibrillation']
