Defibrillation Vector Change in CPR A Systematic Review
Cardiopulmonary resuscitation (CPR) and early defibrillation are essential for managing cardiac arrest. Defibrillation, which interrupts chaotic myocardial electrical activity, has traditionally been performed using an automated external defibrillator (AED) with pads in the anterolateral position. However, in cases of refractory ventricular fibrillation (VF), the effectiveness of this technique may decrease, leading to the exploration of alternatives such as defibrillation vector change. This strategy aims to improve shock efficacy by redistributing the electric field and promoting synchronized myocardial depolarization. This study aims to analyze the scientific evidence on the impact of defibrillation vector change on rhythm conversion, return of spontaneous circulation (ROSC), and survival in patients with cardiac arrest. A systematic review with a meta-analysis of studies published between 2020 and
2025 was conducted, including randomized clinical trials and observational studies on defibrillation pad positioning. The results indicate that both defibrillation vector change and double sequential external defibrillation (DSED) increase the rate of rhythm conversion and ROSC compared to standard defibrillation. However, the impact on long-term survival remains uncertain. Some studies suggest a
slight improvement in survival with DSED, but no statistically significant difference is observed.
The discussion highlights that DSED and defibrillation vector change may be effective strategies for improving rhythm conversion and ROSC. However, their impact on long-term survival is still unclear, and further studies are needed to determine their definitive efficacy. Additionally, the implementation of these techniques requires additional training and standardization of protocols in both prehospital and hospital settings.