Defibrillation strategies for refractory ventricular fibrillation including double sequential external defibrillation (DSED)

Resuscitation Council UK welcomes new research findings about defibrillation strategies for refractory ventricular fibrillation. In their randomised controlled trial, Cheskes and colleagues report that  among patients with refractory ventricular fibrillation (defined as failure to terminate VF after three antero-lateral shocks), survival to hospital discharge was more frequent in those who received double sequential external defibrillation  (DSED) or vector change defibrillation (antero-posterior) compared to those receiving standard defibrillation.1  Vector change defibrillation is already a part of RCUK ALS guidelines for refractory ventricular fibrillation.

The International Liaison Committee on Resuscitation (ILCOR) is currently reviewing this new evidence to update its Consensus on Science  and Treatment Recommendations. RCUK guidelines are based on the ILCOR evidence review, and would consider the additional resources, training and equipment safety issues required to implement DSED. 

RCUK will make any necessary changes to its guidelines following the forthcoming ILCOR update.  

1. Cheskes S, Verbeek PR, Drennan IR, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. New England Journal of Medicine 2022. DOI: 10.1056/NEJMoa2207304