Enhancing Patient Safety in Refractory Ventricular Fibrillation: A Systematic Review of Double Sequential and Vector...

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Research

Background:

• Refractory ventricular fibrillation (RVF) is persistent ventricular fibrillation (VF) after multiple defibrillation attempts, posing a critical challenge in cardiac arrest management.
• Conventional defibrillation strategies are often insufficient for RVF, necessitating exploration of alternative techniques.
• Double sequential external defibrillation (DSED) and vector change (VC) defibrillation are emerging strategies to improve defibrillation success rates.

Purpose of the Study:

• To systematically review the clinical feasibility, safety, and implementation barriers of DSED and VC in managing RVF.
• To evaluate the current evidence base for these alternative defibrillation strategies.
• To identify areas for future research and clinical guideline development.

Main Methods:

• A systematic review adhering to PRISMA 2020 guidelines was conducted.
• Literature search of PubMed, Scopus, and CINAHL databases for studies published between January 2015 and August 2025.
• Inclusion of studies on adult RVF patients treated with DSED or VC, assessing implementation barriers, safety, and methodological limitations. Study quality was assessed using the Newcastle-Ottawa Scale and Cochrane RoB 2 tool.

Main Results:

• Sixteen studies met the inclusion criteria, revealing significant practical and methodological barriers to DSED and VC implementation.
• Practical barriers include the need for dual defibrillators, coordination challenges, protocol inconsistencies, equipment compatibility, and personnel training.
• Methodological barriers encompass small sample sizes, retrospective designs, inconsistent RVF definitions, and incomplete outcome reporting.

Conclusions:

• DSED and VC defibrillation present potential benefits for managing RVF but face substantial implementation hurdles.
• Limited high-quality randomized trials exist, highlighting the need for further research.
• Future studies should employ standardized definitions and safety endpoints to clarify the clinical utility and guide implementation of DSED and VC in refractory VF cases.