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External Defibrillator Damage Associated With Attempted Synchronized Dual-Dose Cardioversion

      The simultaneous use of 2 external defibrillators to administer either dual or sequential cardioversion or defibrillation for refractory cardiac arrhythmias is increasing in both the out-of-hospital and inhospital settings. Using 2 defibrillators to administer higher energy levels than can be achieved with a single defibrillator is considered off-label and is currently not part of published advanced cardiac life support guidelines. We report the first case in which the use of dual-dose cardioversion was associated with external defibrillator damage. Because defibrillator damage, especially if undetected, jeopardizes patient safety and off-label medical product use may void the manufacturer’s warranty, this case should urge users to proceed with caution when contemplating this technique.
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      References

      1. Neubert D. Using double sequential defibrillation to help cardiac arrest patients. Available at: http://www.jems.com/articles/print/volume-41/issue-5/departments-columns/case-of-the-month/using-double-sequential-defibrillation-to-help-cardiac-arrest-patients.html. Accessed February 7, 2017.

      2. City of New Orleans. Region one protocol effort. Available at: http://www.nola.gov/ems/documents/rope-2016-final-v-8-2016-sec/. Accessed February 7, 2017.

        • Cabanas J.G.
        • Myers J.B.
        • Williams J.G.
        • et al.
        Double sequential external defibrillation in out-of-hospital refractory ventricular fibrillation: a report of ten cases.
        Prehosp Emerg Care. 2015; 19: 126-130
        • Gerstein N.S.
        • Shah M.B.
        • Jorgensen K.M.
        Simultaneous use of two defibrillators for the conversion of refractory ventricular fibrillation.
        J Cardiothorac Vasc Anesth. 2015; 29: 421-424
        • Cortez E.
        • Krebs W.
        • Davis J.
        • et al.
        Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest.
        Resuscitation. 2016; 108: 82-86
        • Kabukcu M.
        • Demircioglu F.
        • Yanik E.
        • et al.
        Simultaneous double external DC shock technique for refractory atrial fibrillation in concomitant heart disease.
        Jpn Heart J. 2004; 45: 929-936
        • Saliba W.
        • Juratli N.
        • Chung M.K.
        • et al.
        Higher energy synchronized external direct current cardioversion for refractory atrial fibrillation.
        J Am Coll Cardiol. 1999; 34: 2031-2034
        • Marrouche N.F.
        • Bardy G.H.
        • Frielitz H.J.
        • et al.
        Quadruple pads approach for external cardioversion of atrial fibrillation.
        Pacing Clin Electrophysiol. 2001; 24: 1321-1324
        • Deakin C.D.
        • Kerber R.E.
        Dual sequential defibrillation: does one plus one equal two?.
        Resuscitation. 2016; 108: A1-A2
        • Ross E.M.
        • Redman T.T.
        • Harper S.A.
        • et al.
        Dual defibrillation in out-of-hospital cardiac arrest: a retrospective cohort analysis.
        Resuscitation. 2016; 106: 14-17
        • Merlin M.A.
        • Tagore A.
        • Bauter R.
        • et al.
        A case series of double sequence defibrillation.
        Prehosp Emerg Care. 2016; 20: 550-553
      3. Rio Rancho. Rio Rancho Fire and Rescue EMS treatment guidelines—revised January 2017. Available at: http://www.ci.rio-rancho.nm.us/index.aspx?NID=681. Accessed May 1, 2017.

        • Waller C.
        • Callies F.
        • Langenfeld H.
        Adverse effects of direct current cardioversion on cardiac pacemakers and electrodes: is external cardioversion contraindicated in patients with permanent pacing systems?.
        Europace. 2004; 6: 165-168
        • Levine P.A.
        • Barold S.S.
        • Fletcher R.D.
        • et al.
        Adverse acute and chronic effects of electrical defibrillation and cardioversion on implanted unipolar cardiac pacing systems.
        J Am Coll Cardiol. 1983; 1: 1413-1422
        • Altamura G.
        • Bianconi L.
        • Lobianco F.
        • et al.
        Transthoracic DC shock may represent a serious hazard in pacemaker dependent patients.
        Pace. 1995; 18: 194-198
        • Link M.S.
        • Berkow L.C.
        • Kudenchuk P.J.
        • et al.
        Part 7: adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S444-S464
        • Neumar R.W.
        • Shuster M.
        • Callaway C.W.
        • et al.
        Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S315-S367
        • Schulman P.M.
        • Rozner M.A.
        • Sera V.
        • et al.
        Patients with pacemaker or implantable cardioverter-defibrillator.
        Med Clin North Am. 2013; 97: 1051-1075
        • Laskey W.
        • Awad K.
        • Lum J.
        • et al.
        An analysis of implantable cardiac device reliability. The case for improved postmarketing risk assessment and surveillance.
        Am J Ther. 2012; 19: 248-254
      4. United States Food & Drug Administration. Medsun reports. Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/Medsun/searchreport.cfm. Accessed February 7, 2017.