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Cardiac arrest

AP pad position, not current, predicts ROSC

The impact of defibrillation current and pad position on return of spontaneous circulation during refractory ventricular fibrillation
Resuscitation · Added 25 April 2026

Secondary analysis of DOSE VF examined whether transthoracic current, pad position, and ROSC were linked, and found AP pad placement delivered higher current and was independently associated with ROSC, while delivered current itself was not.

Study type

RCT

Design

Secondary per-protocol analysis of the DOSE VF randomised trial

Participants

342 patients with refractory VF (849 shocks)

Main finding

AP shocks delivered higher current (VC 19.6 A, DSED 19.2 A) than AL shocks (16.6 A) and DSED AL (17.3 A); AP pad position, but not delivered current, was independently associated with ROSC

Caveat

Secondary analysis of a trial population; observational within-trial associations, not a randomised comparison of pad position itself

Bottom line

Supports current practice

Learning goal

Update my approach to pad placement during refractory ventricular fibrillation, weighing whether anterior-posterior positioning improves defibrillation outcomes.

More

• Topic: Cardiac arrest
• Daily scan: 25 April 2026

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