Defibrillation: standard vs. double sequential in adult out-of-hospital cardiac arrest

In 2014, ambulance services across England attempted to treat out-of-hospital cardiac arrest (OHCA) in 28 729 people. Of these, 20.6% presented with a shockable rhythm of either ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) (Hawkes et al, 2017).

However, a subset of patients may remain in VF despite multiple defibrillation attempts (Johnston et al, 2016) and current European Resuscitation Council Guidelines (Soar et al, 2015) and Resuscitation Council UK (2015) Guidelines fail to provide guidance for refractory ventricular fibrillation (RVF) beyond epinephrine and amiodarone administration; high-quality chest compressions; reversible cause treatment; and continued defibrillation.

The current systematic literature review aims to identify and examine key literature in order to determine whether double sequential defibrillation (DSD) for RVF improves patient outcomes in adult non-traumatic OHCA compared with standard defibrillation (SD). Other aims include investigation into reported outcomes, e.g. return of spontaneous circulation (ROSC), survival to discharge (STD), and neurologically intact survival (NIS). This was measured by the Cerebral Performance Category Score (CPCS) which is advocated by the Resuscitation Council UK (2015), whereby a CPCS of 1 or 2 is regarded as a good neurological outcome.