Successful defibrillation using double sequence defibrillation

INTRODUCTION: Defibrillation is effective and the most common treatment for ventricular fibrillation (VF) and pulseless ventricular tachycardia in patients with cardiac arrest. PATIENT CONCERNS: Recently we experienced 3 cases refractory ventricular fibrillation (RVF) which was successfully terminated with double sequence defibrillation (DSD) in our emergency department, so we'd like to report and discuss it. DIAGNOSIS: Cardiac arrest. INTERVENTIONS: A single defibrillation 200J was performed twice for patients with ventricular fibrillation in the initial rhythm of the emergency room. At the same time, intubation and intravenous access were achieved and epinephrine and amiodarone were administered. The 400J DSD was performed on RVF patients with sustained VFs, despite several trials of 150-200J defibrillation and adherence to advanced cardiac life support. OUTCOMES: All three RVF patients recovered spontaneous circulation after DSD. CONCLUSION: The three cases we have shown are small, but DSD improves the chance of spontaneous circulation. Therefore it is suggested that attempts of DSD to patients with RVF, especially in the prehospital stages as a way to improve the return of spontaneous circulation.