Successful prehospital double sequential external defibrillation in a 15-year-old with hypertrophic cardiomyopathy

We present the case of a 15-year-old boy with hypertrophic cardiomyopathy who suffered out-of-hospital cardiac arrest. After failure of conventional defibrillation to terminate refractory ventricular fibrillation, double sequential external defibrillation was used successfully, resulting in return of spontaneous circulation. Ultimately, the patient survived neurologically intact.

Hypertrophic cardiomyopathy is the most common monogenic cardiac disorder. Paediatric hypertrophic cardiomyopathy patients have a higher risk of ventricular fibrillation and sudden cardiac death compared to adults. Double sequential external defibrillation has been successfully used for refractory ventricular fibrillation in the adult population, but is not currently mentioned in paediatric life support guidelines.

We present the case of a 15-year-old boy with hypertrophic cardiomyopathy who suffered out-of-hospital cardiac arrest and persistent ventricular fibrillation. After three failed shocks with an anterolateral defibrillation pad position, double sequential external defibrillation was successfully used as a rescue therapy. A bundle of advanced prehospital interventions, including cerebral near-infrared spectroscopy, invasive blood pressure monitoring and transoesophageal echocardiography, was used to stabilise the patient who ultimately survived without neurological impairment.

This case demonstrates the potential benefit of a double sequential external defibrillation strategy in paediatric patients with refractory ventricular fibrillation. Adequate training is necessary to optimise the efficacy of double sequential external defibrillation. Bundles of advanced prehospital interventions could further contribute to favourable outcomes after prolonged paediatric resuscitation. Registries should be used to systematically capture potential paediatric double sequential external defibrillation candidates to facilitate high-quality observational studies.