[Defibrillation techniques in persistent ventricular fibrillation: which is the most effective?]

A recent study in NEJM (DOSE-VF) showed that administering two consecutive defibrillation shocks with two separate defibrillators improves outcomes for patients with out-of-hospital cardiac arrest (OHCA). This approach was used when a shockable rhythm persisted after three standard shocks, raising the question of new strategies to improve survival for patients with persistent ventricular fibrillation (VF). In the Netherlands, there are around 8,000 OHCA cases annually, with 49% attributed to shockable rhythms. Prompt defibrillation is crucial, but some patients do not respond effectively to it. They may experience rapid VF recurrence or refractory VF, both associated with reduced survival rates. The current European resuscitation protocol emphasizes high-quality chest compressions, early defibrillation, and addressing reversible causes. The DOSE-VF study demonstrated the effectiveness of double sequential external defibrillation (DSED) in improving survival, spontaneous circulation, and neurological outcomes. Techniques such as changing pad positions, increasing initial shock energy, and pad compression can enhance energy transfer. However, implementing double sequential shocks in practice is challenging, requiring two separate defibrillators. The limited effect of this intervention may not warrant changes to extensively trained resuscitation protocols.