Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial

Cheskes, Sheldon; Dorian, Paul; Feldman, Michael J.; McLeod, Shelley; Scales, Damon C.; Pinto, Ruxandra; Turner, Laura; Morrison, Laurie J.; Drennan, Ian R.; Verbeek, P. Richard

doi:10.1016/j.resuscitation.2020.02.010

Cited by 51 publications

(63 citation statements)

References 33 publications

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“…The task force is aware of recently published data from a small pilot RCT comparing standard defibrillation to DSD (adding a second set of defibrillator pads in the anteroposterior position) or to vector change defibrillation (replacing anterolateral pads with anteroposterior pads). 37 The study found differences in VF termination (DSD 76%, vector change 82%, and standard placement 66%) and ROSC (DSD 40%, vector change 39%, and standard defibrillation 25%). This pilot RCT was not designed to formally test differences between the groups, and no survival data were reported.…”

Section: Defibrillation Strategies For Ventricular Fibrillation or Pumentioning

confidence: 86%

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

et al. 2020

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This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.

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Section: Defibrillation Strategies For Ventricular Fibrillation or Pumentioning

confidence: 86%

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

et al. 2020

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“…The ALS Task Force’s SysRev identified only observational studies that were at critical or serious risk of bias because of confounding, and the task force discussed the results of a small RCT comparing standard defibrillation with changing pad position or double sequential defibrillation. 28 Given this very low-certainty evidence, the task force suggested against the routine use of a double sequential defibrillation strategy to treat cardiac arrest with a shockable rhythm.…”

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

Resuscitation

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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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“…The initial phase of this study was conducted as an internal pilot aimed at examining the feasibility of performing this study in the prehospital setting prior to conducting the full RCT [8]. The pilot study was conducted with four of the six paramedic services (Peel, Halton, Simcoe, and Toronto).…”

Section: Internal Pilotmentioning

confidence: 99%

“…The pilot study enrolled 152 patients between March 8, 2018, and September 9, 2019 [8]. Based on the results, it was felt that the pilot study met the criteria to be considered for an internal pilot (high compliance and minor adjustments to the study protocol).…”

Section: Internal Pilotmentioning

confidence: 99%

“…There are a number of possible mechanisms proposed for the effectiveness of DSED. These include increased energy delivery with summated shocks, the addition of an alternative vector of energy delivery (leading to improved current distribution), and decreased shock impedance leading to higher current delivery, thus increasing shock success [8].…”

Section: Introductionmentioning

confidence: 99%

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

Drennan

Dorian

McLeod

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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Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial

Cited by 51 publications

References 33 publications

Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Adult Advanced Life Support: 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

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