Double sequential defibrillation: is it ready for prime time?

Purpose of review Refractory ventricular fibrillation, which fails to respond to defibrillation, is associated with poor survival. Despite this, there are no treatments that are proven effective beyond standard defibrillation and cardiopulmonary resuscitation. Double sequential external defibrillation (DSED) has been proposed as an alternative defibrillation strategy for this patient population. In this review, we will discuss key evidence surrounding DSED, as we present two opposing arguments, ‘pro’ that DSED is ready for clinical practice and ‘con’ that more research is needed prior to implementation of this technique. Recent findings The Double Sequential External Defibrillation for Refractory Ventricular Fibrillation (DOSE VF) randomized clinical trial demonstrated improved patient outcomes for patients with refractory ventricular fibrillation who did not respond to standard defibrillation attempts. There remain unanswered questions with respect to the mechanism by which DSED may improve outcomes and the logistics of implementation into clinical practice. Summary This article discusses some of the key controversies surrounding DSED and whether this novel defibrillation strategy is ready for integration into standard practice. Further research is ongoing that may help to answer further questions related to the utility of DSED.