Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, Puerto Rico.
J Emerg Med. 2020 Oct;59(4):521-541. doi: 10.1016/j.jemermed.2020.06.024. Epub 2020 Jul 29.
Double/dual defibrillation (DD) has been proposed as an alternative treatment for refractory ventricular fibrillation (VF). This topic has been poorly researched and data on survival rates are limited.
This systematic review and meta-analysis evaluates whether DD improves outcomes among patients with refractory VF in- and out-of-hospital cardiac arrest compared with standard defibrillation.
A literature search was conducted on July 20, 2019 using MEDLINE via PubMed, Embase, Scopus, and the Cochrane Database of Systematic Reviews. We gave all results as a pooled odds ratio (OR) and 95% confidence interval (CI). Heterogeneity was assessed by calculating the I statistic and was deemed significant for a p value of < 0.10 or I ≥ 50%. The quality of evidence was evaluated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.
We included 27 records, of which 4 cohort studies totaling 1061 patients were included in the quantitative analysis. Of these, 20.5% (n = 217) received the intervention. DD had no effect on return of spontaneous circulation (OR 0.68; 95% CI 0.44-1.04; I = 41%, p = 0.08) (GRADE: Very low), survival to admission (OR 0.77; 95% CI 0.51-1.17; I = 18%, p = 0.22) (GRADE: Very low), or survival to discharge (OR 0.66; 95% CI 0.38-1.15; I = 0%, p = 0.14) (GRADE: Very low).
DD did not improve any outcomes of interest. Therefore, it is imperative that a well-designed study in this area be conducted. Ideally, conducting a randomized controlled trial in this population should be attempted to obtain a higher level of scientific evidence.
双/双重除颤（DD）已被提议作为治疗难治性心室颤动（VF）的替代方法。这个话题研究得还不够深入，生存率数据有限。
本系统评价和荟萃分析评估了 DD 是否能提高院内和院外心脏骤停的难治性 VF 患者的预后，与标准除颤相比。
我们于 2019 年 7 月 20 日通过 MEDLINE 上的 PubMed、Embase、Scopus 和 Cochrane 系统评价数据库进行了文献检索。我们将所有结果作为汇总优势比（OR）和 95%置信区间（CI）给出。通过计算 I 统计量来评估异质性，如果 p 值<0.10 或 I≥50%，则认为存在显著异质性。证据质量根据推荐评估、制定与评价（GRADE）指南进行评估。
我们纳入了 27 项记录，其中 4 项队列研究共纳入 1061 名患者进行了定量分析。其中，20.5%（n=217）接受了干预。DD 对自主循环恢复（OR 0.68；95%CI 0.44-1.04；I=41%，p=0.08）（GRADE：极低）、入院生存率（OR 0.77；95%CI 0.51-1.17；I=18%，p=0.22）（GRADE：极低）或出院生存率（OR 0.66；95%CI 0.38-1.15；I=0%，p=0.14）（GRADE：极低）均无影响。
DD 并未改善任何感兴趣的结局。因此，在这一领域进行精心设计的研究至关重要。理想情况下，应该尝试在这一人群中进行随机对照试验，以获得更高水平的科学证据。
