![]() 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. 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.
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