• Resuscitation · May 2024

    Randomized Controlled Trial

    The impact of alternate defibrillation strategies on shock-refractory and recurrent ventricular fibrillation: A secondary analysis of the DOSE VF cluster randomized controlled trial.

    • Sheldon Cheskes, Ian R Drennan, Linda Turner, Sandeep V Pandit, and Paul Dorian.
    • Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada; Sunnybrook Research Institute and Department of Emergency Services, Sunnybrook Health Science Centre, 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. Michaels Hospital, Toronto, ON, Canada. Electronic address: sheldon.cheskes@sunnybrook.ca.
    • Resuscitation. 2024 May 1; 198: 110186110186.

    BackgroundThe DOSE VF randomized controlled trial (RCT) employed a pragmatic definition of refractory ventricular fibrillation (VF after three successive shocks). However, it remains unclear whether the underlying rhythm during the first three shocks was shock-refractory or recurrent VF.ObjectiveTo explore the relationship between alternate defibrillation strategies employed during the DOSE VF RCT and the type of VF, either shock-refractory VF or recurrent VF, on patient outcomes.MethodsWe performed a secondary analysis of the DOSE VF RCT. We categorized cases as shock-refractory or recurrent VF based on pre-randomization shocks (shocks 1-3). We then analyzed all subsequent (post-randomization) shocks to assess the impact of standard, vector change (VC) or double sequential external defibrillation (DSED) shocks on clinical outcomes employing logistic regression adjusted for Utstein variables, antiarrhythmics, and epinephrine.ResultsWe included 345 patients; 60 (17%) shock-refractory VF, and 285 (83%) recurrent VF. Patients in recurrent VF had greater survival than shock-refractory VF (OR: 2.76 95% CI [1.04, 7.27]). DSED was superior to standard defibrillation for survival overall, and for patients with shock-refractory VF (28.6% vs 0%, p = 0.041) but not for those in recurrent VF. DSED was superior to standard defibrillation for return of spontaneous circulation (ROSC) and neurologic survival for shock-refractory and recurrent VF. VC defibrillation was not superior for survival or ROSC overall, for shock-refractory, or recurrent VF groups, but was superior for VF termination across all groups.ConclusionDSED appears to be the superior defibrillation strategy in the DOSE VF trial, irrespective of whether the preceding VF is shock-refractory or recurrent.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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