2026 Volume 29 Issue 2 Pages 136-141
Refractory ventricular fibrillation (rVF) refers to ventricular fibrillation that persists despite multiple defibrillation attempts. Double Sequential External Defibrillation (DSED), which delivers rapid sequential shocks using two defibrillators, has recently gained attention following a 2022 randomized trial conducted in Canada. It demonstrated improved rates of VF termination, survival, and neurological outcomes compared with standard defibrillation. However, evidence for its use in emergency department settings remains limited. At our facility, DSED has been implemented since February 2024 for patients presenting with rVF. Among nine patients who underwent DSED, VF termination was achieved in seven cases, return of spontaneous circulation (ROSC) was achieved in four, and two patients were discharged alive; however, both survivors had poor neurological outcomes (CPC 4). DSED may represent a promising option for early defibrillation in rVF. Further studies are warranted to establish optimal DSED protocols in emergency department settings.
