DOSE VF (VC)
Trial question
What is the role of vector-change defibrillation strategy in patients with refractory VF?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
16.0% female
84.0% male
N = 280
280 patients (44 female, 236 male)
Inclusion criteria: adult patients with refractory VF during out-of-hospital cardiac arrest
Key exclusion criteria: traumatic cardiac arrest; pre-existing do not resuscitate orders; VF or VT as presenting rhythm; 3 consecutive shocks delivered; initial treatment by non-participating fire or emergency medical services agencies
Interventions
N=144 VC defibrillation (switching defibrillation pads to an anterior-posterior position)
N=136 standard defibrillation (defibrillation pads placed in the anterior-lateral position)
Primary outcome
Survival to hospital discharge
21.7
13.3
21.7 %
16.3 %
10.8 %
5.4 %
0.0 %
VC
defibrillation
Standard
defibrillation
Significant
increase ▲
NNT = 11
Significant increase in survival to hospital discharge (21.7% vs. 13.3%; RR 1.71, 95% CI 1.01 to 2.88)
Secondary outcomes
Borderline significant increase in termination of VF (79.9% vs. 67.6%; RR 1.18, 95% CI 1.03 to 1.36)
No significant difference in return of spontaneous circulation (35.4% vs. 26.5%; RR 1.39, 95% CI 0.97 to 1.99)
No significant difference in mRS score ≤ 2 (16.2% vs. 11.2%; RR 1.48, 95% CI 0.81 to 2.71)
Conclusion
In adult patients with refractory VF during out-of-hospital cardiac arrest, VC defibrillation was superior to standard defibrillation with respect to survival to hospital discharge.
Reference
Sheldon Cheskes, P Richard Verbeek, Ian R Drennan et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 24;387(21):1947-1956.
Open reference URL