Prehosp Emerg Care. 2016 Jul-Aug;20(4):550-3. doi: 10.3109/10903127.2015.1128026. Epub 2016 Feb 5.
Double Sequence Defibrillation or Double Simultaneous Defibrillation (DSD) is the use of two defibrillators almost simultaneously at their highest allowed energy setting to treat refractory ventricular fibrillation (RVF). One set of pads is placed in the Anterior-Posterior position and the other set of pads is placed in the Anterior-Lateral Position. Both defibrillation buttons are pressed simultaneously. We sought to determine ROSC and survival rates in a large EMS system when DSD is routinely utilized for RVF.
A retrospective case series was performed of all patients who received DSD from January 1, 2015 to April 30, 2015. During the four month period, we requested physicians to instruct paramedics to use DSD on patients after three refractory episodes of VF. All Advanced Cardiac Life Support (ALS) patients treated by paramedics are discussed via telephone communication with a physician in the system of 100 ALS treated patients per day.
From January 1, 2015 to April 1, 2015, a total of 7 patients were treated with DSD. The mean age was 62 (Range: 45-78), with mean resuscitation time of 34.3 minutes before first DSD (Range: 23-48). The mean number of single shocks was 5.4 prior to DSD (Range: 3-9), with a mean of 2 DSD shocks delivered. VF converted after DSD in 5 cases (57.1%). Four patients survived to admission (43%). Three patients survived to discharge with no or minimal neurologic disability (28.6%). The mean Cerebral Performance Category Scale was 3.4 with 1 indicating good cerebral performance and 5 indicating Brain Death.
The correct amount of energy in joules for VF remains unknown. In this case series, significant patients converted out of VF. The reason for improved VF conversion may be several factors including additional defibrillation vectors, increased energy, more energy across myocardium, and unknown variables. Additional research is underway to determine if routine DSD will result in improved survival compared to standard defibrillation techniques.
双相序列除颤或双相同步除颤（DSD）是指在最高允许能量设置下几乎同时使用两台除颤器来治疗难治性心室颤动（RVF）。一组电极片置于前-后位，另一组电极片置于前-外侧位。同时按下两个除颤按钮。我们旨在确定在常规使用 DSD 治疗 RVF 的大型 EMS 系统中，自主循环恢复（ROSC）和存活率。
对 2015 年 1 月 1 日至 2015 年 4 月 30 日期间接受 DSD 的所有患者进行回顾性病例系列研究。在四个月期间，我们要求医生指示护理人员在患者出现三次难治性室颤发作后使用 DSD。通过与系统内每天治疗的 100 名 ALS 患者中的一名医生进行电话沟通，讨论所有由护理人员治疗的高级心脏生命支持（ALS）患者。
从 2015 年 1 月 1 日至 4 月 1 日，共有 7 名患者接受了 DSD 治疗。平均年龄为 62 岁（范围：45-78 岁），首次 DSD 前的平均复苏时间为 34.3 分钟（范围：23-48 分钟）。DSD 前的平均单电冲击次数为 5.4 次（范围：3-9 次），平均给予 2 次 DSD 冲击。5 例（57.1%）在 DSD 后转为窦性心律。4 名患者存活至入院（43%）。3 名患者存活出院，无或轻度神经功能障碍（28.6%）。平均脑功能分类量表（Cerebral Performance Category Scale）为 3.4，其中 1 表示良好的脑功能，5 表示脑死亡。
VF 的正确焦耳能量尚不清楚。在本病例系列中，大量患者转为窦性心律。VF 转化率提高的原因可能有几个因素，包括附加除颤向量、增加能量、更多能量穿过心肌以及未知变量。正在进行更多的研究，以确定常规 DSD 是否会比标准除颤技术导致存活率提高。
Zotero 插件