Defibrillation Strategies for Refractory Ventricular Fibrillation

Stu Berger, MD, Citizen CPR Foundation President, shares the following summary of “Defibrillation Strategies for Refractory Ventricular Fibrillation,” recently published in the New England Journal of Medicine:

Outcomes from sudden cardiac arrest have improved over the years as a result of technological advances in defibrillation techniques and technology. Other interventions that have included community CPR-AED education have also proved to be beneficial. However, shock-refractory ventricular fibrillation (VF) is not uncommon during out-of-hospital-cardiac-arrest (OHCA). This study offers an important discussion of exciting alternatives to shock strategies when conventional approaches fail.

In a randomized-controlled study reported by Cheskes et al. in the New England Journal of Medicine in November 2022, double sequential external defibrillation (rapid sequential shocks from two defibrillators) and vector-change defibrillation (switching defibrillator pads to the anterior-posterior position) have been proposed as techniques to improve outcomes.

In this study, 405 patients were enrolled with a total of 136 (33.6%) receiving standard defibrillation, 144 (35.6%) receiving vector-change defibrillation, and 125 (30.9%) receiving double-sequential external defibrillation. Of importance is the fact that survival to hospital discharge was more common in the double-sequential external defibrillation group than in the standard group (30.4% vs. 13.3%) and more common in the vector-change group than in the standard group (21.7% vs. 13.3%). Double-sequential external defibrillation was associated with a higher recovery of patients having a good neurologic outcome than standard defibrillation.

This paper offers an exciting possibility for improved outcomes by the employment of alternative methods for defibrillation in heretofore shock-refractory VF. Although the logistics of having a second defibrillator present and available might be challenging, the use of vector-change defibrillation with single defibrillator systems might be an alternative strategy when a second defibrillator is not available.

Although this trial was accompanied by/associated with some limitations, particularly with its institution around the time of the COVID-19 pandemic, and the operational challenges associated with that, this trial is indeed significant in that it does show that survival to hospital discharge was significantly improved with double-sequential external defibrillation and vector-change defibrillation compared to standard defibrillation in patients with shock-refractory VF during OHCA. We look forward to more data on these techniques, as well strategies for implementation. Although this is but one study, it is indeed a report of some exciting alternatives to conventional approaches and we look forward to additional studies and education with regard to implementation, if appropriate.

Read the full article on the NLM website >>








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Summit 2023 Exhibitor and Sponsor Opportunities Available Now!

The exciting Summit 2023 news keeps coming! Opportunities to secure your spot as an exhibitor and sponsor are now available. We’ve added several features to help maximize your visibility, interactivity and investment, delivering an outstanding and valuable Summit experience.

Reach out to Ginna Gutierrez at for more information. Or visit our Summit 2023 webpage and download our full exhibitor and sponsor prospectus.

Summit 2023 Call for Presentations Opens Jan. 2, 2023

We’ll open Summit 2023’s Call for Presentations on Jan. 2, 2023. In the meantime, be thinking about how you can help us challenge the status quo in sudden cardiac arrest. With a bias for action, we want presenters to stimulate attendees to think differently about the information presented. We also want to hear what presenters are doing to strengthen connections, communities and commitments to truly make an impact on SCA survival and survivorship.

Deadline for submissions is March 3, 2023.

Join Us Next Year in San Diego!

Planning for the Cardiac Arrest Survival Summit 2023 is officially underway! We’re excited to return to the Town and Country Resort in San Diego, Calif., Nov. 29 – Dec. 2, 2023.

Citizen CPR Foundation’s Cardiac Arrest Survival Summit is the central hub for resuscitation professionals, educators, experts, influencers and advocates, as well as the top decision-makers for resuscitation products, services and information.

We need your help in 2023 to inspire and enable action. Our conference theme is Respond. Revive. SURVIVE: Challenging the Status Quo in SCA. Every two years, the Summit brings together the widest array of resuscitation professionals and advocates in one place. In 2023, that collaboration will help inspire action, giving all attendees tips, insights and next steps that they can take home to their communities. That’s how we’ll continue to work toward our primary goal: improve SCA outcomes, which means more lives saved.

We’ll continue to provide Summit updates here in Currents, other email updates and through our social channels. Connect with us on Twitter, Facebook, LinkedIn and Instagram and stay in the loop as we count down to Summit 2023!


Happy Holidays From Citizen CPR Foundation!

We want to send our holiday wishes to each and every one of you.  All the best to you and your families for a happy, healthy, peaceful and safe holiday season.  And we send our best wishes for an amazing 2023 of continued advocacy and hard work to do all that we can do to save lives from sudden cardiac arrest.  The Citizen CPR Foundation will continue our collaboration with citizens, professionals, communities, survivors and organizations in order to save lives from sudden cardiac arrest.  Thank you for joining us in this endeavor and once again, Happy Holidays!

Stu Berger, MD

President, Citizen CPR Foundation

Paula Lank, BSN, RN

Chair, Citizen CPR Foundation

In Remembrance: George Murphy

Thank you to David Hiltz for writing and contributing this article to Currents.

A dear friend of the resuscitation community and celebrated advocate-champion, George Murphy, NRP, died on June 17, 2022 at the Massachusetts General Hospital.

George Murphy attended the Northeastern University paramedic program where he later earned his degree and worked for Boston EMS for 33 years from 1978 to 2011, retiring as a Captain in the agency’s division of Research, Training and Quality Improvement.

As a member of the Research, Training, and Quality Improvement (RTQI) team at Boston EMS, George was involved in the training and continuing education of Boston EMS’ EMTs and Paramedics. George was a consummate champion of superior care for the people of Boston and integral part of critical strategies designed to introduce new treatment protocols and technologies with the goal of advancing pre-hospital emergency medical care. In George’s case, the focus was clearly on improving outcomes from sudden cardiac arrest.

George was also widely known for his longstanding role as Santa Claus for the City of Boston. Over the years, George became very close to former Mayor Thomas Menino and his wife Angela, appearing as Santa on hundreds of occasions during Menino’s 20-years in office. Anyone who knew George knew of his passion for being Santa.

George was equally well known for dedicating his life to serving others through EMS. He embodied the Latin phrase non-nobis solem as a devoted prehospital care provider, an EMS instructor, a chief EMS examiner and a tireless advocate for patients. His dedication to others was evident in all that he did.

George was also a founding board member and past president of the National EMS Memorial Service, an organization that aims to remember and honor those emergency medical services personnel who have died in the line-of-duty and to recognize the ultimate sacrifice each made for his fellow man.

He was an avid volunteer and served as AHA BLS National Faculty, the Chair of the Massachusetts Emergency Cardiovascular Care Committee and on the American Heart Association New England Affiliate Board of Directors. He actively sought out opportunities to raise awareness of cardiac risk factors, promoting community responsibility, and providing education and training for use of CPR and AED‘s not only in Boston but throughout the United States and beyond. He demonstrated commitment, a culture of action and collaborative spirit at all times, which made him an effective leader.

George thrived on being around people, learning, swapping stories and always encouraging others with his infectious laugh and personality. George is and will be deeply missed by all those whose lives he touched both in-person and through his tireless support of CPR, AEDs and Emergency Cardiac Care.


It has been said that “the heart has a language all its own meaning, which mind alone cannot fully comprehend.” George spoke volumes with his heart and gave of himself with his expertise to anyone. He never turned down a request and instead would commit himself to helping. Rest in peace, George.

—Janet M. Spellman, RN, EMT-P

Paramedic Program Director, Northeastern University (Ret.)


George was a cardiac resuscitation champion nationally, regionally and locally. Gregarious, he knew and worked closely with leadership from the American Heart Association and would bring new ideas and innovations in cardiac and stroke care back to Boston EMS for implementation. George led Boston EMS’s community CPR campaign. In 2005 and the few years thereafter, he organized and coordinated CPR training for all of Boston’s 9,000 public school freshmen. I remember a course for “court-involved youth” that George taught. At their graduation ceremony, the keynote speaker told the graduates that often they had been viewed by themselves and others as problems. CPR had given them a chance to be a part of a solution.

—Peter Moyer, MD, MPH

Professor and Chair Emeritus — Boston University Medicine

Medical Director for Boston EMS, Fire and Police (Ret.)


George Murphy was a larger than life teacher, champion and friend. His big Irish laugh and easy smile filled the room. Everyone enjoyed him and his teaching immensely. His work has and will continue to save lives.

Rest easy.

—Mark Forgues, MEd., NRP

MIT EMS Technical Director (Ret.)

Clinical Training Center at Boston Medical Center


Although George is no longer with us physically, many of us remain standing on his strong shoulders. Thank you, George. You were an incredible mentor and dear friend. Rest easy — we will carry on with you in our hearts.

—David B. Hiltz

Citizen CPR Foundation

Understanding the Importance of the Lay Responder Experience in Out-of-Hospital Cardiac Arrest: A Scientific Statement from the American Heart Association

The following scientific update appears in Currents courtesy of author Katie N. Dainty, PhD, MSc.

For a long time, our entire focus around bystander CPR has been about training people to have the hard skills required to do CPR. While training is an important component of how we will increase survival from sudden cardiac arrest, we have largely ignored the psychology of bystanderism and the impact that our call to action has on responders. A recent scientific statement from the American Heart Association titled “Understanding the Importance of the Lay Responder Experience in Out-of-Hospital Cardiac Arrest” does an excellent job of reviewing this issue for the first time and makes recommendations about how we incorporate existing research into our practices.

For trained or untrained individuals, performing CPR on a real person is a challenging prospect for anyone exposed to an intense emergency situation.  Understanding the ground-level barriers and facilitators to performing CPR may help direct training to improve lay response on a population level.1,2 Studies have shown that the barriers faced by lay responders when confronted with an OHCA are not insignificant and include low self-efficacy, panic, fear of infection or doing the wrong thing, and fear of litigation.3,4,5-8.  Those that have responded have shared that while some were driven by a sense of duty to help and felt empowered by saving a life, most struggle with physical and emotional challenges, sleep disturbance, questioning their actions and an overwhelming feeling that their training did not properly prepare them for the real situation.

Early bystander CPR can double a victim’s chance of survival; it is a crucial intervention in our armament against the overwhelming mortality of sudden cardiac arrest. But as such, it behooves us to fully understand how to harness its power and impact.  We must turn our  attention to understanding how the lived experience of lay responders can help evolve our approaches to communicating about, training for and encouraging bystander CPR and protecting the mental health of those who witness an out-of-hospital cardiac arrest.1 Moving knowledge-to-action is the future of the resuscitation movement.



  1. Dainty KN, Colquitt B, Bhanji F, Hunt EA, Jefkins T, Leary M, Ornato JP, Swor RA, Panchal A. Understanding the Importance of the Lay Responder Experience in Out-of-Hospital Cardiac Arrest: A Scientific Statement from the American Heart Association. Circulation. 2022 Apr 26;145(17): e852-e867.
  2. Vaillancourt C, Stiell IG, Wells GA. Understanding and improving low bystander CPR rates: a systematic review of the literature. CJEM. 2008;10:51–65. doi: 10.1017/s1481803500010010
  3. Sasson C, Haukoos JS, Bond C, Rabe M, Colbert SH, King R, Sayre M, Heisler M. Barriers and facilitators to learning and performing cardiopulmonary resuscitation in neighborhoods with low bystander cardiopulmonary resuscitation prevalence and high rates of cardiac arrest in Columbus, OH. Circ Cardiovasc Qual Outcomes. 2013;6:550–558.4.45
  4. Dobbie F, MacKintosh AM, Clegg G, Stirzaker R, Bauld L. Attitudes towards bystander cardiopulmonary resuscitation: results from a crosssectional general population survey. PLoS One. 2018;13:e0193391.
  5. Johnston TC, Clark MJ, Dingle GA, FitzGerald G. Factors influencing Queenslanders’ willingness to perform bystander cardiopulmonary resuscitation. Resuscitation. 2003;56:67–75.
  6. Coons SJ, Guy MC. Performing bystander CPR for sudden cardiac arrest: behavioral intentions among the general adult population in Arizona. Resuscitation. 2009;80:334–340.
  7. Riegel B, Mosesso VN, Birnbaum A, Bosken L, Evans LM, Feeny D, Holohan J, Jones CD, Peberdy MA, Powell J; PAD Investigators. Stress reactions and perceived difficulties of lay responders to a medical emergency. Resuscitation. 2006;70:98–106.
  8. Kanstad BK, Nilsen SA, Fredriksen K. CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway. Resuscitation. 2011;82:1053–1059.

Drowning and Climate Change

Lifeguards walking along beach

The planet is warming.

“In 2018, we burned a quarter of a million kilograms of coal, 116 million liters of gas, and 7 million liters of oil…every SECOND. In the span of just 50 years, atmospheric CO2 emissions have reached the highest concentrations in over 3 million years. The consequent trapping of longwave radiation has led to energy gain (1750-2011) at a rate the equivalent of four Hiroshima Bombs each SECOND. Polar ice is melting and sea levels are rising. When we add energy to the atmosphere, we get weather – more of it, and ever more extreme,” as outlined in “Matters of Life and Death,” Montgomery & Tipton (2019).

Many of you (myself included) see and feel its effects around you.

What does this have to do with drowning and CPR? We are just returning from the International Drowning Researchers’ Alliance (IDRA) conference, which met to discuss the research agenda for drowning as it relates to climate change. Climate change results in changing drivers for recreational, occupational, and daily interaction with bodies of water, increased frequency of unsafe exposure to water, changing environments locally, changing risks for individuals, changing risks for rescuers, increased burden on rescuers, and increased burden on health services.

We anticipate that, as the planet warms, there will be a growing global burden of drowning. While the initial thought may go to the increased flooding from natural disasters, there are additional considerations. It is forecast that in the next 50 years, 1-3 billion people will be living outside of survivable areas. There will be an additional 750 million that are currently living below the projected high-tide line. These major factors, combined with changing patterns of wild game and inarable soil, will drive massive human migration. Already treacherous routes such as the one from North Africa to Europe will become even more so. Rising water levels and the search for clean drinking water will force billions to make risky crossings to find safety or daily sojourns for fresh water.

More than 90% of global drowning deaths are in low- and middle-income countries. In addition to increased drowning from flooding, migration and reconcentration of populations will cause an increase in diarrheal disease like cholera and zoonotic diseases, including avian influenza, SARS-CoV-2 and monkeypox, among others. Mitigation and response efforts will face new challenges. Increasing temperatures means increased risk to all people for heat illness. Particularly at risk will be rescuers that respond to many of these disasters; consideration must be given to the increased heat stress of rescuers in personal protective equipment such as wetsuits, drysuits, turnout gear, etc. Contamination of floodwaters and rivers with infectious agents, petroleum products, and other toxic chemicals will increase risk to rescuers and the general population alike. Agencies will need to develop strategies to mitigate climate change as well as adapt to the things we cannot change.

One such adaptation that was promoted at the conference, and is currently being implemented, is the use of life jackets during tsunamis. The Maldives recently passed legislation requiring life jackets be placed in every hotel room with the hope that they are utilized if there is a tsunami or flash flood. While it may seem like a simple solution, the logistics can be quite difficult. It is apropos that this model of having life jackets in every room is adapted from the cruise ship industry. Cruise ships are manmade structures subject to the tides and whims of the ocean, able to exist and sustain life through carefully planned and allocated resources. With the contraction of the polar icecap, there has been increased maritime activity in polar waters, especially cruise ships. This change increases the likelihood of the need for remote search and rescue activity over thousands of miles.

At the risk of being doom and gloom, all of this begs the question — What can I do as an individual? The first step is acknowledging that there is a problem and that we must act urgently to mitigate the impending disastrous consequences. The hardest thing to do is to change human behavior and big change is required. Fortunately, this can be accomplished by many small changes. People must demand of their representatives that climate change mitigation is high on the list of priorities. Ask the organizations you deal with if they have a climate change policy, a sustainability officer, environment friendly procurement policies, support those groups that do. Join and support organizations working to save our environment. Then think about all those things you can do personally to reduce your carbon footprint, from travel to local and seasonal eating, and many other actions (The Physiological Society, 2021).

We believe that climate advocate Dr. Elizabeth Sawin said it best: “Everyone doesn’t need to leave their [professional] field and convert to a climate practitioner. But everyone does need to figure out how their field might best contribute to protecting the climate, and how the climate change we can’t prevent will impact their field.”

We hope that this at least starts the conversation. The solutions will not lie just with rescuers and researchers, but will also require accountants, engineers, artists, physiologists, lawyers, and the entire range of human experience and expertise to ensure that our planet is habitable and humane for our children and grandchildren.

Thank you to Justin Sempsrott, MD, an EMS/Emergency Medicine Physician in North Carolina, the co-founder of Lifeguards Without Borders, a 20-year ocean lifeguard with the American Red Cross Volunteer Lifesaving Corps and a previous HEARTSafe Community webinar speaker, for contributing this article to Currents. Dr. Sempsrott’s co-author on the article is Professor Mike Tipton, MBE, PhD, MSc, FTPS, Professor of Human & Applied Physiology, Extreme Environments Laboratory, School of Sport Health & Exercise Science, University of Portsmouth, UK.


Article Sources:

Montgomery H. & Tipton MJ (2019) Matters of life and death: Change beyond planetary homeostasis. Experimental Physiology Editorial.

The Physiological Society (2021) Physiology and climate change. Appendix (Montgomery & Tipton).


Survivors, Rescuers Reunited in New Hampshire

What better way to celebrate the power of the chain of survival, including bystander action, than by reuniting SCA survivors with the people who helped rescue them?

Dartmouth Health member Cheshire Medical Center recently hosted the first Rescuers Reuniting With the Rescued: A Celebration of Survival, bringing together 10 people who experienced SCA in 2021 and those who saved them, including:

  • 911 telecommunications dispatchers
  • Bystanders who performed CPR
  • Law enforcement officers who used AEDs
  • Fire department first responders
  • EMS clinicians

SCA survivors attending the event included Pauline Johansen, 71, who collapsed while raking leaves last September. As Ryan Spencer reported for The Keene Sentinel, two sisters and neighbors — Emma and Camryn Carey — stopped while driving by, called 911 and performed CPR for seven minutes until rescue personnel arrived.

At Rescuers Reuniting with the Rescued, Pauline got to thank Emma and Camryn with a hug.

“I want to thank my guardian angels,” Johansen said, as quoted in The Keene Sentinel.

The event also gave organizers and attendees a chance to recognize the region’s high bystander CPR rates — around 70%, according to a press release from Cheshire Medical Center.

“These high rates are likely due to telecommunicators at 911 recognizing patients who are in cardiac arrest and directing bystanders to perform CPR,” said Jim Suozzi, DO, associate medical director and EMS medical director, Cheshire Medical Center. “National CPR and AED Awareness Week, June 1-7, highlights the importance of knowing how to perform CPR and use an AED. We also wanted to take this opportunity to celebrate these remarkable saves and promote awareness.”

Cheshire Medical Center, Best Western Plus Keene, Tempesta’s Restaurant and ZOLL, a Citizen CPR Foundation partner, teamed up to sponsor Rescuers Reuniting with the Rescued.

Read more about Rescuers Reuniting with the Rescued in The Keene Sentinel and also tune into WKBK Radio’s Good Morning with Dan Mitchell for an interview with a panel of CPR and AED experts, including Dr. Suozzi. If you have an SCA save story that you’d like to share with Citizen CPR Foundation, please reach out to Katy Schamberger. Click here to send Katy an email.