Dual sequential defibrillation: strategies in refractory ventricular fibrillation

Background: Refractory shockable rhythms are associated with mortality as high as 97%. Dual sequential defibrillation has been proposed as a potential solution; debate has heightened following completion of the DOSE VF trial. Aims: This study aimed to identify themes to guide meaningful discussion for future protocol refinement. Methods: Three databases were searched for peer-reviewed research examining dual sequential defibrillation versus standard defibrillation in prehospital settings within the past 10 years. Traumatic and paediatric cardiac arrests were excluded. Findings: The five studies reviewed provided low-certainty evidence with a high risk of bias. Two main themes were identified to guide discussion: defibrillation strategies; and unbalanced gender recruitment. Conclusion: Dual sequential defibrillation was not associated with improved survival to hospital discharge. Further research is warranted, ideally incorporating shock intervals of between 150 ms and 5 seconds provided after 4–8 failed standard defibrillations, and assessment of anatomical pad positioning.