EMCrit 412 - 2025 AHA ACLS Guidelines with Shel Cheskes

The podcast addresses the contrasting 2025 ACLS guidelines from the AHA and ILCOR regarding double sequential external defibrillation (DSED). Emergency medicine professor Sheldon Cheskis critiques the AHA's stance that the usefulness of DSED "has not been established" for persistent VF or pulseless VT after three shocks, arguing it contradicts ILCOR's more permissive "may be considered" recommendation. Cheskis contends the AHA inappropriately focused on "treatment received" rather than "intention to treat" analysis from the Dose VF trial, dismissing the clinical relevance of DSED. He highlights a Swedish study showing significantly improved survival rates when DSED is applied after a single failed shock. The discussion also covers the optimal placement of defibrillation pads, advocating for anterior-posterior placement for more effective current delivery.