Desperate Times Call for Desperate Measures: Double Simultaneous Defibrillation

​Double sequential defibrillation appears to work in the electrophysiology lab, and anecdotal evidence shows that lives can be saved in the prehospital setting and in the emergency department. With all the unanswered questions swirling around it, should we use this technique? Let’s consider the evidence.Using two sets of defibrillators fired simultaneously or in a sequential pattern to treat refractory ventricular fibrillation is a relatively new concept. A number of different names for the procedure exist, but double sequential external defibrillation (DSED) or double simultaneous defibrillation (DSD) are commonly used. This technique was first described in 1994 by Hoch, et al., in five patients who were successfully converted from ventricular fibrillation in an electrophysiology laboratory. (J Am Coll Cardiol 1994;23[5]:1141.) The patients in this report failed to convert to normal sinus rhythm with monophasic energies ranging from 200-360 joules. All of them, however, responded to double shock with a total of 720 joules. The current experience with DSD in treating atrial fibrillation is probably more robust, but the evidence for refractory ventricular fibrillation is mostly case reports and case series. Nonetheless, DSD appears to convert fibrillating hearts and save lives.Multiple questions still surround this off-label use of defibrillators for ventricular fibrillation. There is evidence of safety based on the use of DSD in atrial fibrillation patients, but the p...
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