Initial Double Sequential External Defibrillation for Refractory Ventricular Fibrillation in Cardiac Sarcoidosis.

BACKGROUND

Double sequential external defibrillation (DSED) has demonstrated improved outcomes for refractory ventricular fibrillation (VF). Whether "initial" DSED improves outcomes is an area of ongoing research. We present a case of successful resuscitation employing early DSED.

CASE SUMMARY: A 65-year-old man with cardiac sarcoidosis experienced a witnessed out-of-hospital cardiac arrest. The emergency medical services team confirmed VF and delivered DSED as the initial shock. Resuscitation inclusive of multiple DSED shocks, advanced airway management, amiodarone, and esmolol resulted in a return of spontaneous circulation. Cardiac magnetic resonance imaging confirmed cardiac sarcoidosis, and the patient was discharged with full neurological recovery.

DISCUSSION: This is to our knowledge the first case of DSED used as the initial defibrillation strategy for refractory VF in cardiac sarcoidosis. Initial DSED may offer substantial benefit for high-risk patients, supporting ongoing evaluation of protocols for earlier use of DSED.

TAKE-HOME MESSAGE: DSED can be safely and effectively used as initial therapy in patients with refractory VF.