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The St.Emlyns PodcastAuthor: St Emlyns Blog and Podcast
A UK based Emergency Medicine podcast for anyone who works in emergency care. The St Emlyn s team are all passionate educators and clinicians who strive to bring you the best evidence based education. Our four pillars of learning are evidence-based medicine, clinical excellence, personal development and the philosophical overview of emergency care. We have a strong academic faculty and reputation for high quality education presented through multimedia platforms and articles. St Emlyns is a name given to a fictionalised emergency care system. This online clinical space is designed to allow clinical care to be discussed without compromising the safety or confidentiality of patients or clinicians. Language: en Genres: Health & Fitness, Medicine, Science Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Ep 289 - Refractory VF, Double Sequential Defibrillation, and the Future of Cardiac Arrest
Episode 1
Thursday, 19 March, 2026
What do we really know about treating refractory ventricular fibrillation? And why are we still waiting to use strategies that might actually work? In this episode, we talk to Sheldon Cheskes about the evolving science of cardiac arrest, with a focus on refractory and recurrent ventricular fibrillation. We explore the evidence behind double sequential external defibrillation (DSED), how it compares to standard defibrillation, and what the DOSE VF trial has changed in practice. This is not just about adding another shock. It’s about understanding why defibrillation fails, how vector and energy delivery matter, and when a different approach might improve outcomes. We also discuss: The difference between refractory and recurrent VF — and why it matters What DSED and vector change actually do in physiological terms Why guidelines have been slow to move despite emerging evidence The role of antiarrhythmics, adrenaline, and sequence of care Practical considerations for introducing DSED into real systems What comes next — from smarter detection to post-arrest recovery This is a conversation grounded in real-world resuscitation. It challenges current practice without overselling the evidence. Key Learning Points Refractory VF (persistent after multiple shocks) and recurrent VF (returns after ROSC) are distinct clinical problems with different implications Double sequential external defibrillation (DSED) may improve outcomes in refractory VF by altering current pathways and myocardial depolarisation Timing matters — waiting too long to escalate may reduce the chance of success Current guidelines remain cautious, reflecting the balance between evidence and implementation risk Defibrillation strategy is only one part of a complex system that includes high-quality CPR, drug therapy, and post-resuscitation care Why This Matters Cardiac arrest survival remains low. Small improvements in early resuscitation can have large system-wide effects. Understanding when standard care is failing — and what to do next — is where expertise matters. Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. If you are already listening, you may as well make it count.
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