DOSE VF (DSED)
Trial question
What is the role of double sequential external defibrillation in patients with refractory VF?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
18.0% female
82.0% male
N = 261
261 patients (46 female, 215 male).
Inclusion criteria: adult patients with refractory VF during out-of-hospital cardiac arrest.
Key exclusion criteria: traumatic cardiac arrest; pre-existing DNR orders; VF or VT as presenting rhythm; 3 consecutive shocks delivered; initial treatment by non-participating fire or emergency medical services agencies.
Interventions
N=125 double sequential external defibrillation (rapid sequential shocks from two defibrillators).
N=136 standard defibrillation (defibrillation pads placed in the anterior-lateral position).
Primary outcome
Survival to hospital discharge
30.4%
13.3%
30.4 %
22.8 %
15.2 %
7.6 %
0.0 %
Double sequential external
defibrillation
Standard
defibrillation
Significant
increase ▲
NNT = 5
Significant increase in survival to hospital discharge (30.4% vs. 13.3%; RR 2.21, 95% CI 1.33 to 3.67).
Secondary outcomes
Significant increase in termination of VF (84% vs. 67.6%; RR 1.25, 95% CI 1.09 to 1.44).
Significant increase in return of spontaneous circulation (46.4% vs. 26.5%; RR 1.72, 95% CI 1.22 to 2.42).
Significant increase in mRS score ≤ 2 (27.4% vs. 11.2%; RR 2.21, 95% CI 1.26 to 3.88).
Conclusion
In adult patients with refractory VF during out-of-hospital cardiac arrest, double sequential external defibrillation was superior to standard defibrillation with respect to survival to hospital discharge.
Reference
Sheldon Cheskes, P Richard Verbeek, Ian R Drennan et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 24;387(21):1947-1956.
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