Overall, the trial conducted by Cheskes et al contributes meaningfully to our understanding of the use of alternative defibrillation strategies for refractory ventricular fibrillation before widespread incorporation of double sequential external defibrillation (DSED) and vector-change (VC).

These promising results should be confirmed in future randomized trials with larger sample sizes.

Greater statistical power will improve the reliability of the observed effect size, while likewise reducing natural imbalances between baseline characteristics and prognostic factors between study cohorts.

Among the 405 patients enrolled, a total of 136 patients were assigned to standard defibrillation, 144 to VC defibrillation, and 125 to DSED.

The authors found that both DSED and VC defibrillation were associated with a higher chance of survival to hospital discharge compared with standard defibrillation.

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