Device damage and malfunction during dual defibrillation or dual electrical cardioversion: a scoping review

To map and characterize device damage and malfunction associated with dual defibrillator use in defibrillation and cardioversion, which is increasingly employed in both elective and emergency settings, and to identify knowledge gaps relevant to practice and future research.

We conducted a scoping review in accordance with JBI methodology and PRISMA-ScR. PubMed, Embase, CINAHL, CENTRAL, and gray literature were searched without language or date restrictions. Regulatory adverse event databases were also searched. Eligible sources reported device damage or malfunction associated with two external defibrillators delivering shocks within one second or less of each other.

Twenty-nine records from 2016 to 2026 were included: five published sources and 24 regulatory adverse event reports. Published sources comprised two randomized trials, one survey study, one case report, and one ad-hoc retrospective study. Across five published sources, eight events of lasting device damage and four temporary malfunctions were identified. In published studies, all reported damage events were reported in association with double simultaneous defibrillation or dual cardioversion. Across 24 regulatory reports, 11 records described device damage and 16 described malfunctions. Reported damage was often not recognized during the index event and was instead identified on post-use testing or later routine self-checks.

Device damage and malfunction during dual defibrillator use are documented in both published and regulatory sources. Damage may remain occult until later testing, creating risk beyond the index case. Standardized prospective reporting and routine post-use device testing should be considered wherever dual defibrillator use is employed.