Prehospital Double Sequential Defibrillation: A Matched Case‐Control Study

Abstract

Study Objectives

The goal of our study is to determine if 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 (QA/QI) data obtained from the San Antonio Fire Department out‐of‐hospital cardiac arrest database between JAN 2013 and DEC 2015. The cases were defined as out‐of‐hospital cardiac arrest (OHCA) patients with refractory VF/pVT that survived to hospital admission. The control group was defined as OHCA patients with refractory VF/pVT that 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 3469 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 sixty‐four unique cases and matched them with sixty‐four unique controls. Survival to hospital admission occurred in 48.0% of DSD patients and 50.5% of the conventional therapy patients (p>0.99) (OR 0.91, 95% CI [0.40,2.1]).

Conclusion

Our matched case‐control study on the prehospital use of double sequential defibrillation for refractory ventricular fibrillation/pulseless ventricular tachycardia found no evidence of associated improvement in survival to hospital admission. Our current protocol of considering prehospital double sequential defibrillation after the third conventional defibrillation in out‐of‐hospital cardiac arrest is ineffective.

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