[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-370093-105":59,"doc-detail-370093-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","beyond-advanced-cardiac-life-support-dual-sequential-defibrillation-for-refractory-ventricular-fibrillation-after-witnessed-cardiac-arrest-in-the-emergency-department","Beyond Advanced Cardiac Life Support - Dual-Sequential Defibrillation for Refractory Ventricular Fibrillation after Witnessed Cardiac Arrest in the Emergency Department","","Refractory ventricular fibrillation is a rare cause of cardiac arrest in both in-hospital and out-of-hospital settings. A 56-year-old male developed refractory ventricular fibrillation after an in-hospital arrest with multiple unsuccessful standard defibrillation attempts, and dualsequential defibrillation (DSD) successfully converted the rhythm to normal sinus rhythm. Advanced cardiac life support (ACLS) provides general guidance for cardiopulmonary emergencies but offers no specific recommendations for refractory ventricular fibrillation. This report supports DSD as a potential alternative when ACLS pathways fail.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/beyond-advanced-cardiac-life-support-dual-sequential-defibrillation-for-refractory-ventricular-fibrillation-after-witnessed-cardiac-arrest-in-the-emergency-department/370093/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/beyond-advanced-cardiac-life-support-dual-sequential-defibrillation-for-refractory-ventricular-fibrillation-after-witnessed-cardiac-arrest-in-the-emergency-department/370093.png","ImageObject",300,407,{"name":92,"@type":93},"Connor ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What makes ventricular fibrillation “refractory” in this report?","Question",{"text":113,"@type":114},"The report uses refractory ventricular fibrillation to describe multiple failed attempts (two or more) to correct ventricular fibrillation during cardiopulmonary resuscitation.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did dual-sequential defibrillation (DSD) change the outcome?",{"text":118,"@type":114},"After standard ACLS efforts continued to fail, DSD was attempted by applying a second set of pads in anterior-posterior orientation, leading to successful conversion to normal sinus rhythm.",{"name":120,"@type":111,"acceptedAnswer":121},"Why was point-of-care ultrasound (POCUS) important in the case?",{"text":122,"@type":114},"POCUS was consulted to evaluate right heart strain related to suspected pulmonary embolism, and during the ultrasound the patient experienced ventricular fibrillation, prompting immediate CPR.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},370093,1790242250,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},687207022233,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Open Access Case  \nReport DOI: 10.7759/cureus.3717  \nReceived 11/21/2018  \nReview began 11/28/2018  \nReview ended 12/10/2018  \nPublished 12/11/2018  \n© Copyright 2018  \nFrye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.  \nBeyond Advanced Cardiac Life Support: Dualsequential Defibrillation for Refractory Ventricular Fibrillation after Witnessed Cardiac Arrest in the Emergency Department  \nKenneth L. Frye 1 , Ademola Adewale 2 , Elijah Kennedy 1 , Lisa O 'Grady 1  \n1. Emergency Medicine, Florida Hospital, Orlando, USA 2. Emergency Medicine, Florida Hospital, Orlando , USA Corresponding author: Kenneth L. Frye, [kenneth.frye@gmail.com](kenneth.frye@gmail.com)  \n\n| Abstract\u003Cbr>Refractory ventricular fibrillation is a rare condition seen in both in-hospital and out-of-hospital cardiac arrest. A 56-year-old male was identified to have refractory ventricular fibrillation after an in-hospital cardiac arrest with multiple unsuccessful standard defibrillation attempts that was converted with dualsequential defibrillation (DSD) to normal sinus rhythm. Advanced cardiac life support (ACLS) is the most widely used algorithmic treatment approach for various cardiopulmonary emergencies but has yet to provide recommendations for the treatment of refractory ventricular fibrillation. DSD may be a viable treatment strategy for refractory ventricular fibrillation when ACLS recommendations are ineffective. |\n| --- |\n| Categories: Cardiology, Emergency Medicine\u003Cbr>Keywords: point-of-care ultrasound, dual sequential defibrillation, refractory ventricular fibrillation, emergency medicine, acls, resuscitation, cardiac arrest, pocus\u003Cbr>Introduction\u003Cbr>Cardiac arrest due to refractory ventricular fibrillation is a rare, life-threatening condition, seen in less than 10% of out-of-hospital cardiac arrests [1] . The term refractory ventricular fibrillation is used when there have been multiple failed attempts (two or more) at correcting ventricular fibrillation during cardiopulmonary resuscitation (CPR) [2] . Advanced cardiac life support (ACLS) guidelines help providers with clinical decisions while managing cardiac arrest patients but provide no recommendations for refractory ventricular fibrillation. Here we present a case detailing a potential treatment strategy for refractory ventricular fibrillation using dual-sequential defibrillation (DSD) once the ACLS algorithm pathways have been exhausted.\u003Cbr>Case Presentation\u003Cbr>A 56-year-old male presented to the emergency department (ED) with significant substernal chest pain starting 30 minutes prior to arrival. The patient was immediately brought back to an exam room after an electrocardiogram (ECG) was performed and was seen by a provider within 10 minutes of registration (Figure 1) . |\n| \u003Cbr>\u003Cbr>FIGURE 1 : Electrocardiogram, atrial fibrillation.\u003Cbr>Rate 147, atrial fibrillation, left axis deviation, QRS 84 ms, QTc 404, ST-segments with minimal depression in lateral leads. |\n\nHow to cite this article  \nFrye K L , Adewale A, Kennedy E , et al. (December 11 , 2018) Beyond Advanced Cardiac Life Support: Dual-sequential Defibrillation for Refractory Ventricular Fibrillation after Witnessed Cardiac Arrest in the Emergency Department. Cureus 10(12): e3717. DOI 10.7759/cureus.3717  \nThe initial ECG revealed atrial fibrillation with a rapid ventricular response, rate of 147, with minimal ST depression within the lateral leads but was without apparent ST-segment elevation. On initial assessment, the patient had point-of-care labs immediately drawn (a basic metabolic panel and troponin), and a chest Xray performed to evaluate for a possible aortic dissection which revealed no gross abnormalities (Figure 2) .  \nFIGURE 2: Chest X-ray.  \nPortable chest X-ray, anterior-posterior orientation.  \nWith a non-diagnostic c","cbCaima5itpqTAwV","https://ap.wps.com/l/cbCaima5itpqTAwV","pdf",2894116,"English","# Abstract\n# Introduction\n# Case Presentation\n## Initial presentation and assessment\n## Point-of-care ultrasound and resuscitation\n## ACLS course and decision for DSD\n## Post-stabilization evaluation and recurrence","[{\"question\":\"What makes ventricular fibrillation “refractory” in this report?\",\"answer\":\"The report uses refractory ventricular fibrillation to describe multiple failed attempts (two or more) to correct ventricular fibrillation during cardiopulmonary resuscitation.\"},{\"question\":\"How did dual-sequential defibrillation (DSD) change the outcome?\",\"answer\":\"After standard ACLS efforts continued to fail, DSD was attempted by applying a second set of pads in anterior-posterior orientation, leading to successful conversion to normal sinus rhythm.\"},{\"question\":\"Why was point-of-care ultrasound (POCUS) important in the case?\",\"answer\":\"POCUS was consulted to evaluate right heart strain related to suspected pulmonary embolism, and during the ultrasound the patient experienced ventricular fibrillation, prompting immediate CPR.\"}]","Beyond Advanced Cardiac Life Support - Dual-Sequential Defibrillation for Refractory Ventricular Fibrillation after Witnessed Cardiac Arrest in the Emergency Department | PDF",1790186680,15]