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Early double sequential defibrillation for cardiac arrest outside the hospital

"A Randomized Trial Assessing the Effect of Early Double Sequential Defibrillation With Anterior-posterior and Anterior Lateral Pad Placement and Sequential Defibrillation Compared to Standard Pad Placement and Single Defibrillation in Patients With Out of Hospital Cardiac Arrest With Initial Shockable Rhythm and at Least One Failed Standard Defibrillation"

Phase2; Phase3 Interventional Karolinska Institutet · NCT07174986

We test whether using two defibrillators in quick succession after the first failed shock helps adults with out‑of‑hospital cardiac arrest and a shockable rhythm survive more often than continuing standard single shocks.

Quick facts

PhasePhase2; Phase3
Study typeInterventional
Enrollment916 (estimated)
Ages18 Years and up
SexAll
SponsorKarolinska Institutet Academic / other
Locations14 sites (Amsterdam and 13 other locations)
Trial IDNCT07174986 on ClinicalTrials.gov

What this trial studies

This randomized interventional trial compares double sequential defibrillation (two defibrillators delivering shocks in rapid sequence with anterior‑lateral and anterior‑posterior pad placements) to continued standard single‑defibrillator shocks in adults with out‑of‑hospital cardiac arrest who have an initial shockable rhythm and at least one failed standard shock. Patients are enrolled by participating emergency medical services and assigned to either the DSD strategy or standard care during active resuscitation. The primary focus is survival following early application of DSD, with attention to neurologic outcome and termination of ventricular fibrillation. Children, known DNR patients, and those with obvious pregnancy are excluded.

Who should consider this trial

Good fit: Adults with out‑of‑hospital cardiac arrest whose first monitored rhythm is ventricular fibrillation or pulseless ventricular tachycardia and who have received at least one standard anterior‑lateral defibrillation are the intended candidates.

Not a fit: Patients with non‑shockable rhythms, pediatric patients, those with known do‑not‑resuscitate orders, or obvious pregnancy are not eligible and are unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, this approach could increase survival and improve neurologically intact outcomes for adults with shockable out‑of‑hospital cardiac arrest who don’t respond to an initial defibrillation.

How similar studies have performed: A 2022 prospective cluster randomized trial reported improved survival using DSD or pad‑vector change in refractory VF and ILCOR has endorsed considering DSD after multiple failed shocks, but using DSD immediately after a single failed shock is less tested.

Eligibility criteria

Show full inclusion / exclusion criteria 
Inclusion Criteria:

* OHCA patients with VT/VF at first rhythm analysis and at least one defibrillation performed in standard (A-L) position

Exclusion Criteria:

* Age \< 18 years
* Obvious pregnancy
* Known preexisting Do Not Attempt Resuscitation order

Where this trial is running

Amsterdam and 13 other locations

Study contacts

How to participate

  1. Review the eligibility criteria above with your treating physician.
  2. Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
  3. Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.
View on ClinicalTrials.gov → Find more trials like this →
Conditions Out of Hospital Cardiac ArrestVentricular FibrillationDefibrillationCPRACLSSudden DeathDouble sequential defibrillationDouble sequential external defibrillation
Last reviewed 2026-06-13 by the Find a Trial editorial team. Information on this page is for educational purposes and is not medical advice. Always consult qualified healthcare professionals about clinical trial participation.