Double (dual) sequential defibrillation for refractory ventricular fibrillation cardiac arrest: A systematic review

Deakin, Charles D.; Morley, Peter; Soar, Jasmeet; Drennan, Ian R.

doi:10.1016/j.resuscitation.2020.06.008

“…The task force's SysRev identified only observational studies that were at critical or serious risk of bias because of confounding and 1 recently published small pilot RCT. 31 Effect on treatment recommendations: In this new recommendation, the ALS Task Force suggests against the routine use of a double sequential defibrillation strategy to treat cardiac arrest with a shockable rhythm.…”

Section: Double Sequential Defibrillationmentioning

confidence: 99%

Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Nolan¹,

Maconochie²,

Soar³

et al. 2020

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requiring first aid, related education and implementation strategies, and systems of care. After the publication of the 2015 International Consensus on CPR and ECC Science With Treatment Recommendations, ILCOR also committed to sponsoring a continuous evidenceevaluation process, with topics prioritized for review by the task forces and with CoSTR updates published annually. For this 2020 CoSTR, the 6 ILCOR task forces performed structured reviews of 184 topics, completing the most ambitious evidence review that ILCOR has attempted to date.The ILCOR systematic review process continues to be based on the methodological principles published by the National Academy of Health and Medicine (formerly the Institute of Medicine) 2 ; Cochrane 3,4 ; Grading of Recommendations Assessment, Development, and Evaluation (GRADE) 5 ; and the reporting guidelines based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. 6,7 Three types of evidence evaluation provided the basis for this 2020 CoSTR: the systematic review, the scoping review, and the evidence update. Based on recommendations from the ILCOR Scientific Affairs Committee and agreement of the task forces, only systematic reviews could result in new or modified treatment recommendations.

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“…While DSED has gained popularity among paramedic services, the evidence to date of the benefit of DSED in clinical practice is inconclusive. Previous observational studies have shown no benefit with the use of DSED for refractory ventricular fibrillation in OHCA [9]. This trial will overcome the limitations of previous observational research providing high-quality evidence for the use of DSED and VC defibrillation for OHCA.…”

Section: Discussionmentioning

confidence: 90%

“…Previous research examining the use of DSED for OHCA is limited to case reports and case series as well as a handful of observational studies. Cohort and casecontrol studies have found no difference in survival or neurological outcome when comparing the use of DSED to standard defibrillation for OHCA [9]. These studies, however, are subject to significant biases in the inclusion of patients and application of DSED that make it impossible to draw conclusions regarding the effectiveness of this strategy.…”

Section: Introductionmentioning

confidence: 99%

DOuble SEquential External Defibrillation for Refractory Ventricular Fibrillation (DOSE VF): study protocol for a randomized controlled trial

Drennan

¹

,

Dorian

²

,

McLeod

³

et al. 2020

Trials

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Background Despite high-quality cardiopulmonary resuscitation (CPR), early defibrillation, and antiarrhythmic medications, some patients remain in refractory ventricular fibrillation (VF) during out-of-hospital cardiac arrest. These patients have worse outcomes compared to patients who respond to initial treatment. Double sequential external defibrillation (DSED) and vector change (VC) defibrillation have been proposed as viable options for patients in refractory VF. However, the evidence supporting the use of novel defibrillation strategies is inconclusive. The objective of this study is to compare two novel therapeutic defibrillation strategies (DSED and VC) against standard defibrillation for patients with treatment refractory VF or pulseless ventricular tachycardia (pVT) during out-of-hospital cardiac arrest. Research question Among adult (≥ 18 years) patients presenting in refractory VF or pulseless ventricular tachycardia (pVT) during out-of-hospital cardiac arrest, does DSED or VC defibrillation result in greater rates of survival to hospital discharge compared to standard defibrillation? Methods This will be a three-arm, cluster randomized trial with repeated crossover conducted in six regions of Ontario, Canada (Peel, Halton, Toronto, Simcoe, London, and Ottawa), over 3 years. All adult (≥ 18 years) patients presenting in refractory VF (defined as patients presenting in VF/pVT and remaining in VF/pVT after three consecutive standard defibrillation attempts during out-of-hospital cardiac arrest of presumed cardiac etiology will be treated by one of three strategies: (1) continued resuscitation using standard defibrillation, (2) resuscitation involving DSED, or (3) resuscitation involving VC (change of defibrillation pads from anterior-lateral to anterior-posterior pad position) defibrillation. The primary outcome will be survival to hospital discharge. Secondary outcomes will include return of spontaneous circulation (ROSC), VF termination after the first interventional shock, VF termination inclusive of all interventional shocks, and number of defibrillation attempts to obtain ROSC. We will also perform an a priori subgroup analysis comparing rates of survival for those who receive “early DSED,” or first DSED shock is shock 4–6, to those who receive “late DSED,” or first DSED shock is shock 7 or later. Discussion A well-designed randomized controlled trial employing a standardized approach to alternative defibrillation strategies early in the treatment of refractory VF is urgently required to determine if the treatments of DSED or VC defibrillation impact clinical outcomes. Trial registration ClinicalTrials.gov NCT04080986. Registered on 6 September 2019.

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“…The task force’s SysRev identified only observational studies that were at critical or serious risk of bias because of confounding and 1 recently published small pilot RCT. 31 …”

Section: Advanced Life Supportmentioning

confidence: 99%

Executive Summary 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Nolan¹,

Maconochie²,

Soar³

et al. 2020

Self Cite

View full text Add to dashboard Cite

requiring first aid, related education and implementation strategies, and systems of care. After the publication of the 2015 International Consensus on CPR and ECC Science With Treatment Recommendations, ILCOR also committed to sponsoring a continuous evidenceevaluation process, with topics prioritized for review by the task forces and with CoSTR updates published annually. For this 2020 CoSTR, the 6 ILCOR task forces performed structured reviews of 184 topics, completing the most ambitious evidence review that ILCOR has attempted to date.The ILCOR systematic review process continues to be based on the methodological principles published by the National Academy of Health and Medicine (formerly the Institute of Medicine) 2 ; Cochrane 3,4 ; Grading of Recommendations Assessment, Development, and Evaluation (GRADE) 5 ; and the reporting guidelines based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. 6,7 Three types of evidence evaluation provided the basis for this 2020 CoSTR: the systematic review, the scoping review, and the evidence update. Based on recommendations from the ILCOR Scientific Affairs Committee and agreement of the task forces, only systematic reviews could result in new or modified treatment recommendations.

show abstract

Double (dual) sequential defibrillation for refractory ventricular fibrillation cardiac arrest: A systematic review

Cited by 35 publications

References 26 publications

Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

DOuble SEquential External Defibrillation for Refractory Ventricular Fibrillation (DOSE VF): study protocol for a randomized controlled trial

Executive Summary 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

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