Abstract Body: Background: Refractory ventricular fibrillation (RVF) is VF that persists despite 3 or more single defibrillation attempts. Double sequential defibrillation (DSD) is a proposed defibrillation strategy for RVF that employs delivering 2 rapid sequential, transthoracic electric shocks from 2 separate defibrillators. This meta-analysis aims to identify evidence in the literature surrounding the use of DSD and compare its efficacy with standard defibrillation (SD) in patients with RVF.
Methods: We conducted our meta-analysis in compliance with the PRISMA guidelines. PubMed, Embase, and Cochrane databases were used to retrieve articles. We included studies that evaluated and compared the utility of DSD versus SD in cardiac arrest adult patients who received 3 or more standard defibrillatory shocks for RVF. Our predefined outcomes of interest were VF termination (VFT), return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD). Odds ratio (OR) and 95% confidence intervals (CIs) were calculated using the random-effects model. Heterogeneity was assessed by I² statistic.
Results: A total of 8 studies (2 randomized controlled trials and 6 observational studies) involving 1,579 patients were included in the meta-analysis. No statistically significant difference existed between DSD and SD in terms of VFT (OR, 1.58; 95% CI, 0.84-2.99; p= 0.15; I² =0.54), ROSC (OR, 0.91; 95% CI, 0.53-1.55; p= 0.72; I² =0.76), SHA (OR, 1.18; 95% CI, 0.54-2.55; p= 0.68; I² =0.79), and SHD (OR, 1.03; 95% CI, 0.49-2.17; p= 0.94; I² =0.69). Substantial heterogeneity was noticed across the analysed studies.
Conclusion: Despite the growing use of DSD for the management of RVF, there remains insufficient evidence to support its widespread implementation. This meta-analysis demonstrated that DSD had no statistically significant advantage over SD. However, due to limited data in the literature further clinical trials with large sample sizes are warranted to assess the efficacy and clinical impact of DSD, and whether it can potentially be integrated into resuscitation protocols.