REBEL Crit - By Ramzy M - March 26, 2020
Paper: Cheskes S et al. Double Sequential External Defibrillation for Refractory Ventricular Fibrillation: The DOSE VF Pilot Randomized Controlled Trial. Resuscitation 2020. PMID: 32084567
"Clinical Question: How feasible and safe is a full scale RCT of alternate defibrillation strategies in treating refractory ventricular fibrillation?
Author’s Conclusions:
Our findings suggest the DOSE-VF protocol is feasible and safe. Rates of VFT and ROSC were higher in the VC and DSED than standard defibrillation. The results of this pilot trial will allow us to inform a multicenter cluster RCT with crossover to determine if alternate defibrillation strategies for refractory VF may impact clinical outcomes.
Our Conclusion:
Although a pilot study, the findings of this RCT are promising regarding the role of VC and DSED on VF termination and achieving ROSC. Unfortunately, several methodological flaws still leave many questions unanswered regarding DED. More importantly the impact DED has on patient centered outcomes (ie. mortality, survival to discharge, return to functional activities of daily living, etc) is not addressed and is unclear if it will be in the main RCT. The authors have successfully displayed that a double defibrillation RCT is safe and feasible, however they should consider limiting the number of confounding variables and adding a follow-up component to identify DED’s role in patient centered outcomes.
Clinical Bottom Line:
Emergency physicians should continue to consider the use of a second defibrillator when treating refractory ventricular fibrillation. It isn’t clear from this study if increased ROSC will translate into improve neurologically intact survival. In settings where a second defibrillator is not available or not feasible, changing pad placement from anterolateral to anteroposterior when performing defibrillation may help improve VF termination and achievement of ROSC."