Double Defibrillation for Refractory In- and Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Abstract

Background: Double/dual defibrillation (DD) has been proposed as an alternative treatment for refractory ventricular fibrillation (VF). This topic has been poorly researched and data on survival rates are limited.

Objective: This systematic review and meta-analysis evaluates whether DD improves outcomes among patients with refractory VF in- and out-of-hospital cardiac arrest compared with standard defibrillation.

Methods: A literature search was conducted on July 20, 2019 using MEDLINE via PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews. We gave all results as a pooled odds ratio (OR) and 95% confidence interval (CI). Heterogeneity was assessed by calculating the I² statistic and was deemed significant for a p value of < 0.10 or I² ≥ 50%. The quality of evidence was evaluated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.

Results: We included 27 records, of which 4 cohort studies totaling 1061 patients were included in the quantitative analysis. Of these, 20.5% (n = 217) received the intervention. DD had no effect on return of spontaneous circulation (OR 0.68; 95% CI 0.44-1.04; I² = 41%, p = 0.08) (GRADE: Very low), survival to admission (OR 0.77; 95% CI 0.51-1.17; I² = 18%, p = 0.22) (GRADE: Very low), or survival to discharge (OR 0.66; 95% CI 0.38-1.15; I² = 0%, p = 0.14) (GRADE: Very low).

Conclusions: DD did not improve any outcomes of interest. Therefore, it is imperative that a well-designed study in this area be conducted. Ideally, conducting a randomized controlled trial in this population should be attempted to obtain a higher level of scientific evidence.

Keywords: double defibrillation; double sequential defibrillation; double simultaneous defibrillation; dual defibrillation; in-hospital cardiac arrest; out-of-hospital cardiac arrest; refractory ventricular fibrillation.