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

Stephan Katzenschlager; Raphael Heck; Erik Popp; Frank Weilbacher; Markus A Weigand; Christoph Eisner; Christopher Neuhaus

doi:10.1186/s12245-023-00546-5

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

Int J Emerg Med. 2023 Oct 12;16(1):71. doi: 10.1186/s12245-023-00546-5.

Authors

Stephan Katzenschlager¹, Raphael Heck², Erik Popp², Frank Weilbacher², Markus A Weigand², Christoph Eisner², Christopher Neuhaus²

Affiliations

¹ Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, Heidelberg, 69120, Germany. stephan.katzenschlager@med.uni-heidelberg.de.
² Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Im Neuenheimer Feld 420, Heidelberg, 69120, Germany.

Abstract

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 etCO₂ 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.

Keywords: Advanced life support; Case report; Double sequential external defibrillation; Extracorporeal cardiopulmonary resuscitation; Resuscitation.