Written by Vivian Lei
This small pilot study suggests that vector change defibrillation (VC) and double sequential external defibrillation (DSED) are safe and feasible for termination of refractory ventricular fibrillation (VF) and improve the rate of ROSC.
Why does this matter?
Refractory VF carries a high mortality. Two alternative defibrillation strategies have been proposed, despite variability in execution and quality of evidence:
Double sequential external defibrillation = 2 rapid sequential shocks given via 2 defibrillators with pads attached in 2 different planes
Vector change defibrillation = switching pads from the anterior-lateral to anterior-posterior position
This pilot study sought to determine the feasibility and safety of a full scale RCT comparing these defibrillation strategies with standard care while also providing some outcome data on efficacy of VC and DSED on refractory VF.
This three-arm, cluster-randomized pilot study with crossover was conducted in 4 EMS services in Ontario, Canada. All adults presenting with refractory VF during nontraumatic out of hospital cardiac arrest were included, and each EMS service was randomized to one technique (standard care, VC or DSED) for 6 months and then crossed over to another defibrillation strategy. Of the 152 enrolled patients, 89.5% received the assigned defibrillation strategy, meeting their feasibility endpoint. There were no reported cases of defibrillator malfunction, skin burns, difficulty with pad placement, or concerns expressed about the trial from patients, family, or EMS providers. VF termination was achieved in 66.6% of the standard defibrillation group, compared to 82% of the VC group and 76.3% of the DSED group. ROSC was achieved in 25.0%, 39.3% and 40.0% of standard, VC and DSED groups, respectively. Patient-oriented outcomes were not assessed, but this initial data does offer support of these alternative defibrillation strategies while we await results of the full RCT.
Double Sequential External Defibrillation for Refractory Ventricular Fibrillation: The DOSE VF Pilot Randomized Controlled Trial. Resuscitation. 2020 May;150:178-184. doi: 10.1016/j.resuscitation.2020.02.010. Epub 2020 Feb 19.
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