EMS World Expo 2018

Patients with recurrent or refractory VF represent a challenge for EMS providers in the field. On one hand, the mere presence of VF suggests the arrested heart has energy reserves sufficient to support normal beating if only the arrhythmia would stop and allow the normal pacemaker to take over. However, this energy is finite and without ROSC and restoration of adequate coronary perfusion pressures, fibrillation will deplete the energy reserves in a matter of minutes.  As long as fibrillation is present, termination of resuscitation efforts in the field is inappropriate. Double-sequential or dual defibrillation may offer a therapeutic solution to terminating VF and achieving ROSC when standard defibrillation techniques fail. This presentation will examine the physiology of refractory and recurrent ventricular fibrillation and the latest evidence surrounding double-sequential defibrillation.