Out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) is a catastrophic life event. Its course turns even more ominous when these rhythms prove to be shock-refractory. Antiarrhythmic drugs such as amiodarone or lidocaine in the United States and Europe and nifekalant in Japan, are often deployed in such circumstances in hope of restoring spontaneous circulation (ROSC) and to improve survival. Yet, even after many years of use, doubts linger over the efficacy and effectiveness of these drugs. Two recent reports in the Journal ask which antiarrhythmic drug (if any) is best for treating shock-refractory OHCA? In doing so, they raise an important additional question, namely what counts and what doesn’t when making such an assessment?

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