![]() ![]() There was also a recent retrospective case series by Cabanas JG et al of 10 cases of refractory VF.All 5 patients finally converted after getting a double shock with a total of 720J There is also an older case series in JACC from 1994 that describes 5 patients with cardiomyopathy or Wolff-Parkinson-White (WPW) Syndrome undergoing electrophysiology studies failing to convert out of VF after 7 – 20 shocks with monophasic energies ranging from 200 – 360J.Although this was a swine model, Zhang Y et al did show that there was an inverse relationship of body mass with successful defibrillation. The amount of tissue that electricity has to get through will affect the amount of effective energy that will be delivered to the fibrillating heart. Lets face it our population is not getting thinner. Body habitus is an important variable for successful defibrillation.So after high quality CPR, multiple rounds of defibrillation, and appropriate medications, if you still have refractory VF, why not just give this a try? What do you have to lose? The patient is going to die if you are not able to get a perfusing rhythm. I am talking about the patient who you have tried to defibrillate several times unsuccessfully I am talking about thinking outside the box. I am not talking about doing this on every patient with VF. Now I get it, in the scheme of evidence based medicine, case reports are amongst one of the lowest forms of evidence, but hear me out.Simultaneously press the shock button on both monitorsĪll of the above are acceptable ways to place the pads Discussion:.Ensure everyone is clear of the patient.Charge both monitors (360J for monophasic and 200J for biphasic).Using a second defibrillator, you can place a second set of external defibrillation pads next to each other, but ensure that the pads are not making contact with each other.This procedure should only be used in refractory ventricular fibrillation after multiple attempts at defibrillation and appropriate medications have been given.How do you perform dual simultaneous external defibrillation? Describe a novel approach of “high-energy” defibrillation in a patient with intractable VF after cardiac arrest.Although VF typically responds very well to the standard energies of defibrillation, maybe in patients with higher body mass index or morbid obesity we need higher energies to achieve successful defibrillation. For those of us in the trenches of the emergency department, we have to think beyond ACLS at times. For many who have heard me speak about ACLS, you have heard me say that these guidelines are created for the providers who do not perform resuscitation as part of their daily routine. What we all know is that high-quality, limited interruption cardiopulmonary resuscitation (CPR) and early defibrillation are the hallmarks of successful neurologic outcomes in OHCA. The majority of OHCA is due to cardiac etiology with the most common initial rhythm being ventricular fibrillation (VF). Even more concerning is the high mortality rate which is associated with this. Background: Out-of-hospital cardiac arrest (OHCA) occurs in the United States at a rate of nearly 300,000 individuals per year. ![]()
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