Defibrillation Strategies for Refractory Ventricular Fibrillatio

This multicenter, cluster-randomized trial (DOSE VF) compared three defibrillation strategies standard defibrillation, vector-change (VC) defibrillation, and double sequential external defibrillation (DSED) for patients with refractory ventricular fibrillation during out-of-hospital cardiac arrest. Among 405 adults enrolled across six Canadian paramedic services, survival to hospital discharge was significantly higher with DSED (30.4%; RR: 2.21; 95% CI: 1.33–3.67) and VC (21.7%; RR: 1.71; 95% CI: 1.01–2.88) compared to standard defibrillation (13.3%). DSED also improved good neurologic outcomes (27.4% vs. 11.2%; RR: 2.21), termination of ventricular fibrillation, and return of spontaneous circulation. VC showed benefit in rhythm termination but neurologic outcomes were not statistically superior. All patients received high-quality CPR and standardized drug protocols. The trial was halted early due to pandemic-related operational challenges. Findings support DSED and VC as promising techniques for refractory ventricular fibrillation, with DSED showing the most robust results. Future implementation may hinge on logistical feasibility and broader validation.

This multicenter, cluster-randomized trial (DOSE VF) compared three defibrillation strategies standard defibrillation, vector-change (VC) defibrillation, and double sequential external defibrillation (DSED) for patients with refractory ventricular fibrillation during out-of-hospital cardiac arrest. Among 405 adults enrolled across six Canadian paramedic services, survival to hospital discharge was significantly higher with DSED (30.4%; RR: 2.21; 95% CI: 1.33–3.67) and VC (21.7%; RR: 1.71; 95% CI: 1.01–2.88) compared to standard defibrillation (13.3%). DSED also improved good neurologic outcomes (27.4% vs. 11.2%; RR: 2.21), termination of ventricular fibrillation, and return of spontaneous circulation. VC showed benefit in rhythm termination but neurologic outcomes were not statistically superior. All patients received high-quality CPR and standardized drug protocols. The trial was halted early due to pandemic-related operational challenges. Findings support DSED and VC as promising techniques for refractory ventricular fibrillation, with DSED showing the most robust results. Future implementation may hinge on logistical feasibility and broader validation.