The Critical Care Commute Podcast Dose VF: Defibrillation Done Right! With Prof. Sheldon Cheskes
Mar 25, 2026
Sheldon Cheskes, a professor and leading resuscitation researcher behind the DOSE VF trial, walks through advanced defibrillation tactics. He discusses double sequential defibrillation, vector-change and pad positioning. Timing of shocks and medications, early intervention benefits, and practical stepwise protocols are highlighted.
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26-Year-Old Survival Sparked DSED Trial
- Sheldon Cheskes described a 26-year-old postpartum patient who survived after paramedics performed double sequential defibrillation (DSED) following five shocks, epinephrine, and amiodarone.
- That single case prompted years of observational work and ultimately the DOSVF randomized trial to test DSED formally.
How Double Sequential Defibrillation Works
- DSED means adding anterior-posterior (AP) pads to existing anterior-lateral (AL) pads and delivering two shocks in quick succession, about 500 milliseconds apart.
- In practice Cheskes had teams press the AL defibrillator first then the AP, creating sequential shocks to maximize myocardial current delivery.
AP Pads Deliver More Current And Better ROSC
- AP pad placement delivers lower transthoracic impedance and thus higher current to the heart compared with AL, increasing odds of ROSC roughly twofold in their analysis.
- Cheskes' EMS now starts with AP pads because current path matters more than nominal energy (joules).