Double Sequential Defibrillation: An Update of Contemporary Defibrillation Strategies for Pulseless Ventricular Tachycardia and Fibrillation

In a clinical trial, the role of double sequential external defibrillation (DSED) in treating refractory ventricular fibrillation (VF) was evaluated. Many Americans suffer from sudden cardiac arrest daily, and resuscitation rates are low especially in patients with refractory ventricular tachycardia (VT)/fibrillation. This trial was a prehospital resuscitation trial exploring methods to improve meaningful survival in this difficult patient cohort. I applaud the efforts of this trial, along with all of those involved in research and education, in trying to improve outcomes by improving recognition and bystander CPR, reducing delays in EMS activation, initiating CPR and the first delivery of a defibrillation shock, and adjusting pad placement to more successfully defibrillate the patient. In this editorial, I discuss in detail the outcomes of this landmark clinical trial, along with supplemental information submitted by the primary authors. Also, I review the updated defibrillation outcomes by defibrillator pad placement and defibrillation vectors. Finally, I give my recommendation to not include DSED in contemporary resuscitation guidelines and my rationale and justification for my recommendation.