Initial Double Sequential External Defibrillation for Refractory Ventricular Fibrillation in Cardiac Sarcoidosis
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".