• Neal S Gerstein, A Robb McLean, Eric C Stecker, and Peter M Schulman.
• Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM. Electronic address: ngerstein@gmail.com.
• Ann Emerg Med. 2018 Jan 1; 71 (1): 109-112.

AbstractThe 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.Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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