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In cardiac arrest, if the initial rhythm is ventricular fibrillation (VF) or pulseless ventricular tachycardia, the survival rates are high and good neurologic outcomes are expected. However, the mortality rate increases when refractory ventricular fibrillation (RVF) occurs. We report a case of RVF that was successfully resuscitated with double sequence defibrillation (DSD). A 51-year-old man visited the emergency department with chest pain. The initial electrocardiography showed markedly elevated ST-segment on V1–V5 leads, and VF arrest occurred. Although 10 defibrillations were administered over 20 minutes, there was no response. Two rounds of DSD were performed by placing additional pads on the patient’s anterior-posterior areas and sequentially applying the maximum energy setting. The patient returned to spontaneous circulation and was discharged with cerebral performance category 1 after 14 days of hospital admission. Therefore, DSD could be an option for treatment and termination of RVF.

Additional file 2: Table S1. Comparison of baseline characteristics between patients of KoCARC registry and the study cohort.

Purpose: The history, electrocardiogram, age, risk factor, and troponin (HEART) score have not yet been adopted in the emergency department (ED) in South Korea. We aimed to investigate whether patients with low HEART scores have a low risk of coronary angiography (CAG) results. Methods: Patients with chest pain with a possible cardiac etiology in the ED were included. Patients were divided into low-risk (0 – 3), intermediate-risk (4 – 6), and high-risk (7 – 9) groups according to the HEART score. We analysed the CAG results of the included patients. CAG results were divided into four grades: Grade I, > 70%; Grade II, > 50%; Grade III, 10% – 50%; and Grade IV, < 10%of stenosis. The occurrence of a major adverse cardiac event (MACE) within 28 days was also investigated. Results: The study included 787 patients, of whom 458, 262, and 67 were included in the low-risk, intermediate-risk, and high-risk groups, respectively. A total of 118 cases of MACE occurred (average: 0.15 MACE/patient). MACE incidence was lower in the low-risk HEART score group than in the intermediate-risk and high-risk groups (0.4% vs. 22.1% and 86.6%, p < 0.001). The CAG results of the admitted patients with a low-risk HEART score were as follows: Grade I, 6.1%; Grade II, 3.0%; Grade III, 27.3%; and Grade IV, 63.6%. Conclusions: Patients with a low HEART score visiting the ED in Korea had a low risk in CAG results and a low probability of developing MACE. The successful utilization of the HEART score appears to be a rational approach that may avoid unnecessary testing in chest pain patients presenting to the ED.