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. 2019 Sep;26(9):994-1001.
doi: 10.1111/acem.13672. Epub 2019 Jan 6.

Prehospital Double Sequential Defibrillation: A Matched Case-Control Study

Julian G Mapp  1   2 , Alan J Hans  1 , Anthony M Darrington  1 , Elliot M Ross  1   2 , Calvin C Ho  3 , David A Miramontes  2 , Stephen A Harper  1   2 , David A Wampler  2 ; Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME) Research Group
Affiliations
Free article

Prehospital Double Sequential Defibrillation: A Matched Case-Control Study

Julian G Mapp et al. Acad Emerg Med. 2019 Sep.
Free article

Abstract

Objectives: The goal of our study was to determine whether prehospital double sequential defibrillation (DSD) is associated with improved survival to hospital admission in the setting of refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT).

Methods: This project is a matched case-control study derived from prospectively collected quality assurance/quality improvement data obtained from the San Antonio Fire Department out-of-hospital cardiac arrest (OHCA) database between January 2013 and December 2015. The cases were defined as OHCA patients with refractory VF/pVT who survived to hospital admission. The control group was defined as OHCA patients with refractory VF/pVT who did not survive to hospital admission. The primary variable in our study was prehospital DSD. The primary outcome of our study was survival to hospital admission.

Results: Of 3,469 consecutive OHCA patients during the study period, 205 OHCA patients met the inclusion criterion of refractory VF/pVT. Using a predefined algorithm, two blinded researchers identified 64 unique cases and matched them with 64 unique controls. Survival to hospital admission occurred in 48.0% of DSD patients and 50.5% of the conventional therapy patients (p > 0.99; odds ratio = 0.91, 95% confidence interval = 0.40-2.1).

Conclusion: Our matched case-control study on the prehospital use of DSD for refractory VF/pVT found no evidence of associated improvement in survival to hospital admission. Our current protocol of considering prehospital DSD after the third conventional defibrillation in OHCA is ineffective.

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