Double Sequential Defibrillation for Refractory Ventricular Fibrillation During Resuscitative Thoracotomy: A Case Report

In-hospital cardiac arrest (IHCA) is associated with improved outcomes compared to out-of-hospital cardiac arrest (OHCA), largely due to immediate access to advanced resuscitative interventions. Double sequential defibrillation (DSD) is an emerging technique that has demonstrated potential benefit in cases of refractory ventricular fibrillation (RVF), though its use has primarily been described in closed-chest resuscitation. We present a case of a male patient of unknown age, estimated to be in his third decade of life, who developed RVF following a penetrating gunshot wound to the abdomen. Despite resuscitative thoracotomy and attempted internal defibrillation, sustained ROSC was not achieved until DSD was performed using external defibrillation pads. DSD was initiated after approximately 11 minutes of unsuccessful standard resuscitative measures, including internal cardiac massage and multiple defibrillation attempts. Although the patient ultimately succumbed to non-survivable aortic injuries discovered intraoperatively, this case demonstrates the feasibility and potential effectiveness of DSD in an open-chest resuscitation setting. To our knowledge, this represents the first reported use of DSD following resuscitative thoracotomy.