Dual Sequential Defibriliation

[Achilles]

Michigan recently re vamped many of their protocols including AED placement and dual sequential shocking. I did a search and found some older threads on the topic, but I'm interested to see if anyone else's MCA has adopted it, in addition to that, they also want anterior posterior placement for pads. Have those that have had MCA opt in for it, have you found it to be effective? Our protocols want it done, but then contradict themselves to say "follow Manufacturer's recommendation on pad placement"
The dual sequential is after an AED has shocked 3 times, so rare, albeit could happen i suppose.
Two questions in one, sorry for the sloppiness in paragraph structure.

 

[DesertMedic66]

Several years ago we switched to the AP placement for the defibrillation pads so that is our go to. If we have done multiple defibrillations with success in converting then we will do a vector change and place another set of pads in the “traditional” location and attempt further defibrillations.

We one medic attempt a double sequential defibrillation however it was unsuccessful and both the medic and the base hospital physician got in some trouble for doing it.

 

[Tigger]

We have it in our guidelines for use after three consecutive unsuccessful shocks. We are supposed to do AP pad placement on the first set but that has been difficult to get buy in on. Agencies that use the Zoll X have really struggled as you have to remove the CPR puck and people don’t do that. We also don’t use amiodarone or lidocaine in our system in cardiac arrest so take that for what it’s worth.

I did it once seven years ago when our wildman medical director wanted us “to be the first.” And it worked great!

 

[johnrsemt]

We have talked about it at my PT job; thought and talked a lot about doing it on a patient in and out of Cardiac arrest back in January: 135 mile transport, in and out 7 times. We we decided to do it the next time he coded, (we were 35 miles into the transport: no cell or radio service) he stopped coding and the rest of the transport was boring except bagging him.
We had 2 monitors, so we could have done it, and probably wouldn't have gotten in trouble, but I think trying to hit both buttons at the exact same time would be hard

 

[FiremanMike]

We have talked about it at my PT job; thought and talked a lot about doing it on a patient in and out of Cardiac arrest back in January: 135 mile transport, in and out 7 times. We we decided to do it the next time he coded, (we were 35 miles into the transport: no cell or radio service) he stopped coding and the rest of the transport was boring except bagging him.
We had 2 monitors, so we could have done it, and probably wouldn't have gotten in trouble, but I think trying to hit both buttons at the exact same time would be hard

it depends entirely on the protocol, but you can do them 1 right after the other or at the same time.

 

[Akulahawk]

Most of the stuff I've seen about dual sequential defibrillation has been regarding serial defibrillations, immediately one then the other. This is different than dual simultaneous defibrillation. From what I've read, both approaches work. The idea is to depolarize as much of the myocardium as possible and utilizing different electrical pathways across the heart could get other portions of the myocardium to depolarize if it hadn't done so on the first shock.

I just hope we don't go so far as to attempt quintuple simultaneous defibrillations at 360J in the very refractory cases...

 

[PotatoMedic]

I just hope we don't go so far as to attempt quintuple simultaneous defibrillations at 360J in the very refractory cases...

I was thinking maybe continuous defibrillation using a car battery and jumper cables.

 

[FiremanMike]

Most of the stuff I've seen about dual sequential defibrillation has been regarding serial defibrillations, immediately one then the other. This is different than dual simultaneous defibrillation. From what I've read, both approaches work. The idea is to depolarize as much of the myocardium as possible and utilizing different electrical pathways across the heart could get other portions of the myocardium to depolarize if it hadn't done so on the first shock.

I just hope we don't go so far as to attempt quintuple simultaneous defibrillations at 360J in the very refractory cases...

I don’t know that there will ever be enough data to truly evaluate the efficacy of DSD.. Persistent ventricular rhythms are so few and far between..

 

[Summit]

I just hope we don't go so far as to attempt quintuple simultaneous defibrillations at 360J in the very refractory cases...

Let's just transcutaneously pace at 15A