Successful resuscitation of refractory ventricular fibrillation with double sequence defibrillation

In cardiac arrest, if the initial rhythm is ventricular fibrillation (VF) or pulseless ventricular tachycardia, the survival rates are high and good neurologic outcomes are expected. However, the mortality rate increases when refractory ventricular fibrillation (RVF) occurs. We report a case of RVF that was successfully resuscitated with double sequence defibrillation (DSD). A 51-year-old man visited the emergency department with chest pain. The initial electrocardiography showed markedly elevated ST-segment on V1–V5 leads, and VF arrest occurred. Although 10 defibrillations were administered over 20 minutes, there was no response. Two rounds of DSD were performed by placing additional pads on the patient’s anterior-posterior areas and sequentially applying the maximum energy setting. The patient returned to spontaneous circulation and was discharged with cerebral performance category 1 after 14 days of hospital admission. Therefore, DSD could be an option for treatment and termination of RVF.