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Related Experiment Video

Updated: Dec 28, 2025

A Model of Long-Term Ventricular Fibrillation in Isolated Rat Hearts
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Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized

Sheldon Cheskes1, Paul Dorian2, Michael Feldman3

  • 1Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada; Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, Ontario, Canada.

Resuscitation
|February 22, 2020
PubMed
Summary

This pilot study found that alternative defibrillation strategies, vector change (VC) or double sequential external defibrillation (DSED), are feasible and safe for refractory ventricular fibrillation (VF). These methods showed higher rates of VF termination and return of spontaneous circulation compared to standard defibrillation.

Keywords:
Cardiopulmonary resuscitationDefibrillationDouble sequential external defibrillationHeart arrestPrehospital careResuscitation

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Clinical Trials

Background:

  • Refractory ventricular fibrillation (VF) poses a significant challenge in out-of-hospital cardiac arrest (OHCA).
  • Standard defibrillation protocols may be insufficient for patients with persistent VF.
  • Novel defibrillation strategies are needed to improve patient outcomes.

Purpose of the Study:

  • To determine the feasibility and safety of a pilot cluster randomized controlled trial (RCT) with crossover.
  • To compare vector change (VC) defibrillation and double sequential external defibrillation (DSED) against standard defibrillation for refractory VF.
  • To assess the rates of VF termination (VFT) and return of spontaneous circulation (ROSC) with different defibrillation strategies.

Main Methods:

  • A pilot cluster RCT with crossover design was conducted across four Canadian paramedic services.
  • Adult OHCA patients presenting with VF receiving at least three defibrillation attempts were enrolled.
  • Paramedic services were randomized to standard defibrillation, VC, or DSED, with a crossover after six months.

Main Results:

  • The study enrolled 152 patients, demonstrating high adherence to allocated defibrillation strategies (89.5%).
  • No safety concerns were reported during the trial.
  • VF termination rates were 66.6% for standard, 82.0% for VC, and 76.3% for DSED.
  • ROSC rates were 25.0% for standard, 39.3% for VC, and 40.0% for DSED.

Conclusions:

  • The DOSE-VF protocol, utilizing VC and DSED, is feasible and safe for managing refractory VF.
  • VC and DSED demonstrated higher VFT and ROSC rates compared to standard defibrillation in this pilot study.
  • Results support informing a larger multicenter RCT to confirm the clinical impact of these alternative defibrillation strategies.