Abstract
Alternative strategies for defibrillation improve outcomes in patients with refractory ventricular fibrillation, according to findings from the DOSE VF trial.
Subject terms: Ventricular fibrillation
Alternative strategies for defibrillation improve outcomes in patients with refractory ventricular fibrillation. This finding comes from the DOSE VF trial, which was presented at the AHA Resuscitation Science Symposium 2022 and published in NEJM.
In a cluster-randomized trial performed in Canada, six paramedic services were randomly assigned to treat patients with refractory ventricular fibrillation during out-of-hospital cardiac arrest with one of three defibrillation strategies: double sequential external defibrillation (DSED; rapid sequential shocks from two defibrillators), vector-change defibrillation (VCD; switching the defibrillation pads to an anterior–posterior position) or standard defibrillation.
The trial was stopped because of the COVID-19 pandemic after 405 patients had been enrolled. Survival to hospital discharge was higher in the DSED and VCD groups than in the standard group (30.4%, 21.7% and 13.3%, respectively). DSED, but not VCD, was associated with a higher likelihood of a good neurological outcome than standard defibrillation.
The results seem to favour DSED, but the requirement for a second defibrillator might be a limitation to widespread uptake of this strategy. In these settings, the use of VCD might be a suitable alternative strategy.
References
Original article
- Cheskes S, et al. Defibrillation strategies for refractory ventricular fibrillation. N. Engl. J. Med. 2022 doi: 10.1056/NEJMoa2207304. [DOI] [PubMed] [Google Scholar]