Double Sequential Shocks for Refractory Rhythms

Recently we have seen publication of the DOSE-VF trial, which is the first randomized controlled trial directly comparing either Double Sequential External Defibrillation (DSED) or Vector Change (VC) defibrillation to a common control group of standard defibrillation for adult patients remaining in refractory VF during out-of-hospital cardiac arrest. It was a cluster randomized trial with crossover conducted in 6 Canadian paramedic services. Patients remaining in VF after treatment with advanced life support and three consecutive standard defibrillation attempts were treated by additional standard defibrillation, DSED or VC defibrillation according to the randomly allocated strategy assigned to the paramedic service. The primary outcome was survival to hospital discharge.

The trial showed significantly improved mortality for patients receiving either DSED or VD compared to standard defibrillation. You can read more here:

https://link.springer.com/article/10.1007/s00134-023-06993-1