![]() ![]() Double-sequential defibrillation: Two shocks administered one after the other with a gap of less than 1 second, with pads in the antero-lateral and antero-posterior positions.Conventional defibrillation with pads in the antero-lateral position.Each cluster was meant to undergo each of the three strategies at least once. Each cluster crossed over to one of the other strategies every 6 months. The study patients received one of three types of defibrillation – conventional, vector-change, or double-sequential defibrillation, based on the randomly assigned intervention for the cluster. This was a three-group, cluster randomized trial. Cardiac arrest due to trauma, drowning, hanging, suspected drug overdose, and hypothermia were excluded. Refractoriness was defined as VF or pulseless ventricular tachycardia as the initial rhythm that did not respond to three standard defibrillation attempts between 2-min intervals of cardiopulmonary resuscitation (CPR). Adult patients above 18 years of age, who suffered out of hospital cardiac arrest and experienced refractory ventricular fibrillation (VF) were included. The study was conducted across six paramedic services in Ontario, Canada between March 2018 and May 2022. Change of vector may result in a higher voltage and offers the potential to defibrillate parts of the ventricle that may be relatively inaccessible to conventional pad positioning. Fibrillation is most likely to return or fail to terminate after defibrillation in these areas of the left ventricle when standard pad position is used. The left ventricle lies posteriorly hence, a shock delivered through anterior pads may not have an effective impact on some parts of the left ventricle. Early application of DSED or VC may lead to improved rates of defibrillation and return of spontaneous circulation, and thereby, lead to more favorable clinical outcomes. ![]() In observational studies and case reports, these strategies have been tried out mainly as a last resort in refractory ventricular fibrillation. PMID: 36342151.ĭouble sequential (DSED) and vector change (VC) defibrillation have been in use for many years. Defibrillation Strategies for Refractory Ventricular Fibrillation. Cheskes S, Verbeek PR, Drennan IR, et al. ![]()
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