First 10EM - By Justin Morgensten - Published March 2, 2020
"Double sequential defibrillation has been all the rage over the last few years in emergency medicine. If one shock isn’t enough, use two. (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. (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.
The paper: Cheskes S, Dorian P, Feldman M, et al. DOuble Sequential External Defibrillation for Refractory Ventricular Fibrillation: The DOSE VF Pilot Randomized Controlled Trial. Resuscitation. 2020; PMID: 32084567 [article] NCT03249948
Bottom line
This small pilot study suggests that ROSC may be improved with double sequential defibrillation (and also with vetor change defibrillation) for patients with refractory ventricular fibrillation. It isn’t clear if this will translate into improved neurologically intact survival, but I think it is enough to support the practice while waiting for more data."