329 Out-of-Hospital Double Sequential Defibrillation of Refractory Ventricular Fibrillation Associated With Improved Outcomes

Out-of-hospital cardiac arrest is associated with higher survival rates when treated with early defibrillation. In cases of refractory ventricular fibrillation (v-fib), double sequential defibrillation (DSD) has been proposed as an effective alternative treatment. We aimed to track the outcomes after DSD for refractory v-fib in the field. Our county EMS system is one of the largest in our state. This analysis is a subset of our county EMS out-of-hospital IRB approved research registry that tracks all adult cardiac arrests. This dataset encompasses all patients in a 24-month period who underwent double sequential defibrillation after refractory v-fib. Refractory v-fib was defined as v-fib that did not convert after 3 full shocks. A total of 31 cases met the criteria for refractory v-fib. The additional set of pads were placed in the antero-postero direction. The energy applied was 200J, and the shock-to-shock cycle time was less than 20 seconds. Seven patients achieved return of spontaneous circulation (ROSC) and six patients made it to hospital discharge (fig 1). Double sequential defibrillation is a viable option for patients in refractory v-fib in patients who would be otherwise dead. Our data demonstrates that DSD is feasible in the field and is associated with ROSC in ¼ of cases, and with survival to hospital discharge in 1 out of every 5 cases.