Out-of-hospital cardiac arrest treated with prehospital double sequential external defibrillation during eCPR in refractory VF — a case report

BACKGROUND: Double sequential external defibrillation (DSED) has demonstrated increased survival with good neurological outcome in a recent randomized controlled trial. DSED has not been studied in patients with extracorporeal cardiopulmonary resuscitation (eCPR). CASE: We present the first case of prehospital eCPR with ongoing refractory ventricular fibrillation (VF), terminated by DSED. After six shocks, return of spontaneous circulation was initially achieved; however, the patient went into recurrent VF. ECPR was performed prehospital, with VF still refractory after three more shocks. DSED successfully terminated VF and showed a further increase in etCO(2) and near-infrared spectroscopy cerebral oximetry values. CONCLUSION: DSED can be a sufficient strategy for patients in refractory VF while on eCPR and should be evaluated in further studies.