![]() ![]() 9 Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada Sunnybrook Research Institute, Toronto, Ontario, Canada. ![]() Michaels Hospital, Toronto, Ontario, Canada Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada. 8 Li Ka Shing Knowledge Institute, St.7 Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada.6 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.Michaels Hospital, Toronto, Ontario, Canada Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada. 5 Li Ka Shing Knowledge Institute, St.4 Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Ontario, Canada.3 Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada.Michaels Hospital, Toronto, Ontario, Canada. 1 Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada Li Ka Shing Knowledge Institute, St.Patient-oriented outcomes were not assessed, but this initial data does offer support of these alternative defibrillation strategies while we await results of the full RCT.ĭouble Sequential External Defibrillation for Refractory Ventricular Fibrillation: The DOSE VF Pilot Randomized Controlled Trial. ROSC was achieved in 25.0%, 39.3% and 40.0% of standard, VC and DSED groups, respectively. VF termination was achieved in 66.6% of the standard defibrillation group, compared to 82% of the VC group and 76.3% of the DSED group. There were no reported cases of defibrillator malfunction, skin burns, difficulty with pad placement, or concerns expressed about the trial from patients, family, or EMS providers. Of the 152 enrolled patients, 89.5% received the assigned defibrillation strategy, meeting their feasibility endpoint. All adults presenting with refractory VF during nontraumatic out of hospital cardiac arrest were included, and each EMS service was randomized to one technique (standard care, VC or DSED) for 6 months and then crossed over to another defibrillation strategy. This three-arm, cluster-randomized pilot study with crossover was conducted in 4 EMS services in Ontario, Canada. This pilot study sought to determine the feasibility and safety of a full scale RCT comparing these defibrillation strategies with standard care while also providing some outcome data on efficacy of VC and DSED on refractory VF. Vector change defibrillation = switching pads from the anterior-lateral to anterior-posterior position Two alternative defibrillation strategies have been proposed, despite variability in execution and quality of evidence:ĭouble sequential external defibrillation = 2 rapid sequential shocks given via 2 defibrillators with pads attached in 2 different planes This small pilot study suggests that vector change defibrillation (VC) and double sequential external defibrillation (DSED) are safe and feasible for termination of refractory ventricular fibrillation (VF) and improve the rate of ROSC. ![]()
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