Use of double sequential external defibrillation in the United States before and after the DOSE VF randomized clinical trial

OBJECTIVES: The Double Sequential External Defibrillation for Refractory Ventricular Fibrillation (DOSE VF) trial demonstrated improved outcomes for patients randomized to double sequential external defibrillation (DSED) in comparison to standard defibrillation, yet large-scale data on prehospital DSED use remain limited. We evaluated prehospital DSED use before and after publication of DOSE VF. METHODS: test and an interrupted time-series analysis using segmented Poisson regression with 3-month non-overlapping segments. RESULTS: We identified 16,450 DSED-eligible patients treated by 906 emergency medical services agencies. Estimates of DSED use varied by ascertainment method (Method 1: 3.7%, Method 2: 1.8%, Method 3: 4.4%, any method: 7.6%). The use of DSED detected by any method increased post-DOSE VF (pre vs. post: 822/11,228 (7.3%) vs. 381/4,625 (8.2%), p = 0.048). Segmented Poisson regression suggested an increase in the rate of DSED use (slope change) after DOSE VF (RR: 1.09 (1.04, 1.14) per quarter). CONCLUSIONS: Our findings suggest an increasing rate of DSED use after publication of DOSE VF, but the proportion of eligible patients receiving DSED remains low. Limitations include the potential for patient misclassification by our DSED ascertainment methods.