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Double sequential defibrillation

Chady El Tawil, Sandra Mrad, Basem F Khishfe
A 54-year-old suffered from an out-of-hospital cardiac arrest. Compressions were started within minutes and the patient was in refractory ventricular fibrillation despite multiple asynchronized shocks and maximal doses of antiarrhythmic agents. Double sequential defibrillation was attempted with successful Return Of Spontaneous Circulation (ROSC) after a total of 61min of cardiac arrest. The patient was discharged home neurologically intact. Double sequential defibrillation could be a simple effective approach to patients with refractory ventricular fibrillation...
December 2017: American Journal of Emergency Medicine
Amber C Emmerson, Mark Whitbread, Rachael T Fothergill
BACKGROUND: Despite advances in treatment for out-of-hospital cardiac arrest (OHCA), a subgroup of patients remain in refractory ventricular fibrillation (RVF) during resuscitation. Recent evidence suggests that double sequential defibrillation (DSD), where two shocks are delivered to the patient in quick succession, may provide an effective therapy for RVF. This study describes the characteristics and survival outcomes of OHCA patients treated by ambulance clinicians using a local DSD protocol in an attempt to resolve RVF...
August 2017: Resuscitation
Joshua Pound, P Richard Verbeek, Sheldon Cheskes
BACKGROUND: High quality cardiopulmonary resuscitation (CPR) has produced a relatively new phenomenon of consciousness in patients with vital signs absent. Further research is necessary to produce a viable treatment strategy during and post resuscitation. OBJECTIVE: To provide a case study done by paramedics in the field illustrating the need for sedation in a patient whose presentation was consistent with CPR induced consciousness. Resuscitative challenges are provided as well as potential future treatment options to minimize harm to both patients and prehospital providers...
March 2017: Prehospital Emergency Care
Eric Cortez, William Krebs, James Davis, David P Keseg, Ashish R Panchal
INTRODUCTION: Survival from out of hospital cardiac arrest (OHCA) is highest in victims with shockable rhythms when early CPR and rapid defibrillation are provided. However, a subset of individuals present with ventricular fibrillation (VF) that does not respond to defibrillation (refractory VF). One intervention that may be a possible option in refractory VF is double sequential external defibrillation (DSD). The objective of this case series was to describe the outcome of prehospital victims with refractory VF treated with DSD in the out-of-hospital setting...
November 2016: Resuscitation
David Neubert
Double sequential defibrillation is currently being employed in a number of EMS systems across the United States, including Wake County, N.C.; Fort Worth, Texas; and New Orleans. Even though there isn't a large body of literature surrounding this technique, it's been demonstrated successful in the electrophysiology lab, ED and prehospital settings. Since access to procainamide--another treatment for refractory v fib--is limited, this may be the only available option when faced with a patient who's failed standard ACLS defibrillation and medication administration...
May 2016: JEMS: a Journal of Emergency Medical Services
Martin Johnston, Sheldon Cheskes, Garry Ross, P Richard Verbeek
BACKGROUND: Patients who present in ventricular fibrillation are typically treated with cardiopulmonary resuscitation (CPR), epinephrine, antiarrhythmic medications, and defibrillation. Although these therapies have shown to be effective, some patients remain in a shockable rhythm. Double sequential external defibrillation has been described as a viable option for patients in refractory ventricular fibrillation. OBJECTIVE: To describe the innovative use of two defibrillators used to deliver double sequential external defibrillation by paramedics in a case of refractory ventricular fibrillation resulting in prehospital return of spontaneous circulation and survival to hospital discharge with good neurologic function...
September 2016: Prehospital Emergency Care
Aurora M Lybeck, Hawnwan Philip Moy, David K Tan
A 40-year-old male struck his chest against a pole during a basketball game and had sudden out-of-hospital cardiac arrest. After bystander cardiopulmonary resuscitation, fire and emergency medical services personnel provided six defibrillation attempts prior to emergency department arrival. A 7th attempt in the emergency department using a different vector was unsuccessful. On the 8th attempt, using a second defibrillator with defibrillator pads placed adjacent to the primary set of defibrillator pads, two shocks were administered in near simultaneous fashion...
2015: Prehospital Emergency Care
José G Cabañas, J Brent Myers, Jefferson G Williams, Valerie J De Maio, Michael W Bachman
Abstract Background. Ventricular fibrillation (VF) is considered the out-of-hospital cardiac arrest (OOHCA) rhythm with the highest likelihood of neurologically intact survival. Unfortunately, there are occasions when VF does not respond to standard defibrillatory shocks. Current American Heart Association (AHA) 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 VF. Objective. To describe a technique of double sequential external defibrillation (DSED) for cases of refractory VF (RVF) during OOHCA resuscitation...
January 2015: Prehospital Emergency Care
William T Abraham, Angel R León, Martin G St John Sutton, Steven J Keteyian, Ann M Fieberg, Ed Chinchoy, Garrie Haas
BACKGROUND: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality and improves symptoms in patients with systolic heart failure (HF) and ventricular dyssynchrony. This randomized, double-blind, controlled study evaluated whether optimizing the interventricular stimulating interval (V-V) to sequentially activate the ventricles is clinically better than simultaneous V-V stimulation during CRT. METHODS: Patients with New York Heart Association (NYHA) III or IV HF, meeting both CRT and implantable cardioverter-defibrillator indications, randomly received either simultaneous CRT or CRT with optimized V-V settings for 6 months...
November 2012: American Heart Journal
Aladár Rónaszéki, Marco Alings, Kenneth Egstrup, Zbigniew Gaciong, Marián Hranai, Csaba Király, Matyas Sereg, Wlodzimierz Figatowski, Patrik Bondarov, Susanne Johansson, Lars Frison, Nils Edvardsson, Anders Berggren
AIM: AZD1305 is a combined ion channel blocker developed for the treatment of atrial fibrillation (AF). The aim of this study was to determine whether AZD1305 was effective in converting AF to sinus rhythm (SR). METHODS AND RESULTS: Patients with AF episodes of duration 3 h to 3 months were randomized in a 3:1 ratio to receive a maximum 30 min intravenous infusion of AZD1305 or matching placebo. The primary efficacy endpoint was the proportion of patients converting within 90 min of the start of infusion, after which patients who had not converted were to undergo direct current (DC) cardioversion...
August 2011: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Charles J Lick, Tom P Aufderheide, Robert A Niskanen, Janet E Steinkamp, Scott P Davis, Susan D Nygaard, Kim K Bemenderfer, Louis Gonzales, Jeffrey A Kalla, Sarah K Wald, Debbie L Gillquist, Michael R Sayre, Susie Y Osaki Holm, Susie Y Oski Holm, Dana A Oakes, Terry A Provo, Ed M Racht, John D Olsen, Demetris Yannopoulos, Keith G Lurie
OBJECTIVES: To determine out-of-hospital cardiac arrest survival rates before and after implementation of the Take Heart America program (a community-based initiative that sequentially deployed all of the most highly recommended 2005 American Heart Association resuscitation guidelines in an effort to increase out-of-hospital cardiac arrest survival). PATIENTS: Out-of-hospital cardiac arrest patients in Anoka County, MN, and greater St. Cloud, MN, from November 2005 to June 2009...
January 2011: Critical Care Medicine
Enrique Velázquez Rodríguez, Agustín Martínez Enríquez, Carlos Cancino Rodríguez, Gabriel Olvera Morales, Javier Rangel Rojo, Sergio Arias Estrada
BACKGROUND: Clinical studies have shown that transthoracic cardioversion of atrial fibrillation is dependent on achieving adequate current flow to the heart, which is dependent on transthoracic impedance. When multiple standard cardioversion fails to restore sinus rhythm in patients with atrial fibrillation the double sequential transthoracic shock may be an alternative. METHODS AND RESULTS: Twenty one consecutive patients with paroxysmal or persistent atrial fibrillation refractory to at least two initial high energy 360 J or 200-300 and 360 J monophasic shocks underwent double sequential shocks with 720 J by means two defibrillators...
July 2005: Archivos de Cardiología de México
Bruce D Adams, David M Easty, Elaine Stuffel, Irma Hartman
INTRODUCTION: Time to defibrillation (T(defib)) is the most important modifiable factor affecting survival from cardiac arrest. Mortality increases by approximately 7--10% for each minute of defibrillation delay. The purpose of this study was to determine whether defibrillator electrode design complexity affects T(defib). METHODS: This was a randomized sequential design study utilizing a standardized ventricular fibrillation cardiac arrest model for CPR mannequins...
August 2005: Resuscitation
D H Hoch, W P Batsford, S M Greenberg, C M McPherson, L E Rosenfeld, M Marieb, J H Levine
OBJECTIVES: A technique for terminating refractory ventricular fibrillation is described. BACKGROUND: Refractory ventricular fibrillation can occur in up to 0.1% of electrophysiologic studies. Animal studies have shown that rapid sequential shocks may reduce ventricular fibrillation threshold. METHODS: Five patients of 2,990 consecutive patients in a 3-year period experienced refractory ventricular fibrillation during 5,450 routine electrophysiologic studies...
April 1994: Journal of the American College of Cardiology
M S Chang, H Inoue, M J Kallok, D P Zipes
The role of optimal placement of electrodes and mode of shock delivery from a defibrillator was examined in dogs with and without myocardial infarction. Single, double and triple truncated exponential shocks separated by 1 ms were delivered through various electrode combinations and cardiac vectors after electrical induction of ventricular fibrillation. A single shock through a pathway not incorporating the interventricular septum (catheter electrodes or epicardial patches between anterior and posterior left ventricle) required the highest total energy (22...
December 1986: Journal of the American College of Cardiology
K Murphy, R M Nowak, M C Tomlanovich
We conducted a study to determine if bretylium tosylate (BT) is effective in the prophylaxis and treatment of hypothermic ventricular fibrillation (VF) in the setting of various maneuvers thought to induce this lethal arrhythmia. Twenty-two mongrel dogs were cooled to 24 C after being placed in a cold room. At 24 C, a double-blinded placebo or BT solution was infused. The dogs then were removed from the cold. They underwent the following sequential maneuvers: oral endotracheal extubation and intubation, central line and nasogastric tube placement, vigorous movement, and Swan-Ganz catheter insertion...
October 1986: Annals of Emergency Medicine
A Hannekum, H Dalichau, M Kochs, H Müller, M Höher, H Hirche
With introduction of the automatic implantable cardioverter-defibrillator for treatment of medically refractory ventricular arrhythmias, many investigations are focussing on possibilities of reducing the energy necessary for defibrillating the heart to obtain a more adequate size and a longer durability of the generator. Several studies favour the sequential pulse delivery, using three electrodes, either endocardial, epicardial or subcutaneous plates, to improve defibrillation performance of low energy shocks...
October 1987: Thoracic and Cardiovascular Surgeon
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