153 Double Sequential Defibrillation in Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Analysis

The goal of our study is to determine if out-of-hospital double sequential defibrillation (DSD) is associated with better neurologically intact survival in out-of-hospital cardiac arrest. This study is a retrospective cohort analysis of prospectively collected quality assurance/quality improvement data from a large urban fire-based EMS system out-of-hospital cardiac arrest (OHCA) database between January 2013 and December 2015. Our inclusion criteria were administration of DSD or at least four conventional 200J defibrillations for cases of recurrent and refractory ventricular fibrillation (VF). We excluded any case with incomplete data. The primary outcome for our study was neurologically intact survival (defined as Cerebral Performance Category 1&2). A total of 3470 cases of OHCA were treated during the time period of January 2013 to December 2015. There were 302 cases of recurrent and refractory VF identified. Twenty-three cases had incomplete data. Of the remaining 279 cases, 50 were treated with DSD and 229 received standard single shock 200J defibrillations. There was no statistically significant difference in the primary outcome of neurologically intact survival between the DSD group (6%) and the standard defibrillation group (11.4%) (p=0.317) (OR 0.50, 95% CI 0.15-1.72). Our retrospective cohort analysis on the out-of-hospital use of DSD in OHCA found no evidence of associated improvement in neurologically intact survival. Case-control and randomized controlled studies are needed to further evaluate the efficacy of DSD before we can establish any potential benefit in the out-of-hospital setting.