Methodology: 4.5/5
Usefulness: 4.5/5

Cheskes S, et al. N Engl J Med. 2022 Nov 6.

Question and Methods: A cluster-randomized open-label trial evaluating survival in adult patients with refractory ventricular fibrillation during OHCA treated by paramedics with standard defibrillation versus DSED and VC defibrillation.  
Findings: Survival to hospital discharge was improved in patients that received DSED (30.4%, RR 2.21 (95% CI 1.33-3.67)) and VC (21.7%, RR 1.71 (95% CI 1.10-2.88)) when compared to standard defibrillation (13.3%).  
Limitations: Limitations included the trial being stopped early leading to an underpowered study and possible overestimation of treatment effect, and the fact that blinding would not be possible in this study.  

Interpretation: Patients with OHCA and refractory ventricular fibrillation likely benefit from early DSED over standard defibrillation. VC defibrillation can be considered over standard defibrillation when DSED is not feasible.  

By: Dr. Chirag Bhat

Supervisor: Dr. Krishan Yadav