Double sequential defibrillation trial#

Although ROSC may appear to be higher in the double sequential defibrillation group, we should be very cautious interpreting those numbers without statistics. This is only a pilot study, and therefore is not designed to give us practice changing information. There were no adverse events in any of the groups. The numbers were still higher but less impressive if you just look at who had a pulse on arrival to the ED (19% standard care, 25% vector change, and 33% double sequence). Return of spontaneous circulation was obtained in 25% of the standard care group, 39% of the vector change group, and 40% of the double sequence defibrillation group. They don’t include statistics or 95% confidence intervals. 93% had their assigned therapy by the 6th shock. 77% of patients were able to get their assigned therapy on the 4th shock (the earliest possible time). They were able to demonstrate that this treatment is feasible, with 89% of patients getting their assigned therapy. Their safety outcome looked at damage to the machine, chest wall burns, and any concerns from paramedics, emergency department staff, patients, or their families.Ĭlinically, they looked at VF termination and ROSC to inform the sample size of the main study. They had a primary feasibility outcome of ensuring they could successfully deliver the assigned therapy to 80% of eligible patients. Standard care (continued standard ACLS with shocks given through the same pads in the same anterior-lateral position). Pad placement for double sequential defibrillation. Vector change defibrillation (switching pads from the anterior lateral to anterior posterior position).This was done because simultaneous shocks can damage the machines. They had a single paramedic operate both machines, so there was a longer delay between the two shocks than in some previous descriptions.

Double sequential external defibrillation (2 shocks given via 2 defibrillators with pads attached in different positions).They excluded patients with trauma, DNR orders, hypothermia, suspected overdose, hanging, or drowning. Refractory was defined as having failed 3 defibrillation attempts with the pads in the standard anterior-lateral position, however they only counted shocks given by the EMS service, so some patients had received extra shocks before being enrolled. They included all adult patients with refractory VF arrest (but not patients with pulseless ventricular tachycardia) during a non-traumatic out of hospital cardiac arrest. The entire agency performed one technique for 6 months, and every agency crossed over to at least 1 other technique. The randomization was at the level of the EMS agency.

Double sequential defibrillation trial#

This is a three-arm, pilot, cluster randomized trial with crossover conducted in 4 EMS services in Ontario, Canada. DOuble Sequential External Defibrillation for Refractory Ventricular Fibrillation: The DOSE VF Pilot Randomized Controlled Trial. The paperĬheskes S, Dorian P, Feldman M, et al. (Mapp 2019 Emmerson 2017 Cheskes 2019) However, we now have the first proper randomized trial looking at the practice, and the results aren’t bad. (By that logic, I am sort of surprised that no one has moved on to triple sequential defibrillation yet, but there is still time.) There has never been great evidence for the practice, and actually some observational data suggesting it might not be helpful. Double sequential defibrillation has been all the rage over the last few years in emergency medicine.