Defibrillation after Cardiac Arrest — Is It Time to Change Practice

This editorial analyzes the implications of the DOSE VF trial, which compared three defibrillation strategies standard, double sequential external defibrillation (DSED), and vector-change (VC) defibrillation for refractory ventricular fibrillation in prehospital cardiac arrest. Among 405 patients, DSED led to significantly higher survival to hospital discharge (30.4%) versus standard defibrillation (13.3%; RR = 2.21; 95% CI: 1.33–3.67), with improved neurologic outcomes. VC also showed benefit (21.7%; RR = 1.71; 95% CI: 1.01–2.88) but lacked statistically significant neurologic advantage. Authors note methodological caveats: early trial termination due to pandemic constraints, modest sample size versus intended power, and absence of postresuscitation care data (e.g., temperature management, coronary intervention). Implementation of DSED poses logistical challenges, including equipment and training needs, and carries potential technical risks. Despite these limitations, the trial offers compelling effectiveness data and advocates further research into defibrillation approaches and post-arrest care. DSED and VC defibrillation may serve as viable alternatives when standard measures fail, though they are not yet ready for routine clinical use.

This editorial analyzes the implications of the DOSE VF trial, which compared three defibrillation strategies standard, double sequential external defibrillation (DSED), and vector-change (VC) defibrillation for refractory ventricular fibrillation in prehospital cardiac arrest. Among 405 patients, DSED led to significantly higher survival to hospital discharge (30.4%) versus standard defibrillation (13.3%; RR = 2.21; 95% CI: 1.33–3.67), with improved neurologic outcomes. VC also showed benefit (21.7%; RR = 1.71; 95% CI: 1.01–2.88) but lacked statistically significant neurologic advantage. Authors note methodological caveats: early trial termination due to pandemic constraints, modest sample size versus intended power, and absence of postresuscitation care data (e.g., temperature management, coronary intervention). Implementation of DSED poses logistical challenges, including equipment and training needs, and carries potential technical risks. Despite these limitations, the trial offers compelling effectiveness data and advocates further research into defibrillation approaches and post-arrest care. DSED and VC defibrillation may serve as viable alternatives when standard measures fail, though they are not yet ready for routine clinical use.