Double Sequential Defibrillation In Prehospital Care: A Review Of Evidence And Outcomes In Refractory Ventricular Fibrillation

Abstract

Refractory ventricular fibrillation (RVF) remains one of the most challenging conditions encountered in prehospital cardiac arrest care, often associated with poor outcomes despite adherence to established Advanced Cardiac Life Support (ACLS) guidelines. Conventional defibrillation and pharmacologic interventions frequently fail to achieve return of spontaneous circulation in these patients, highlighting the urgent need for innovative strategies. Double sequential defibrillation (DSD), also known as dual defibrillation, has emerged as a novel technique in which two defibrillators deliver sequential or simultaneous shocks through different vectors, theoretically increasing myocardial depolarization and improving defibrillation success. Although initially reported in case studies and small observational series, DSD has gained attention in emergency medical services as a potential intervention for RVF in out-of-hospital cardiac arrest. Early evidence suggests that DSD may improve rates of return of spontaneous circulation and survival to hospital admission, yet definitive outcomes on long-term survival and neurological function remain inconclusive due to limited randomized controlled trials and heterogeneous protocols. This review synthesizes available literature on DSD in prehospital care, examines comparative outcomes against standard approaches, identifies barriers to implementation, and outlines strategies for integration into emergency response systems. Future research is essential to determine the role of DSD in guideline-based practice.