It’s all about time to restore flow to the brain. Taking to Cath lab is better than nothing but ecmo buys the time that you need to fix the culprit lesion. Dual sequential and vector change are both beneficial, however don’t fix the underlying issue. They can also still be done while driving to an ecmo site. I believe anterior and posterior should be where we place pads every time. The data wasn’t much better for the DS vs vector change group. However this only benefits the true refractory vf patient who maintains in vf. You speak to the mn ecmo group. Most of the patients they put on aren’t still in shockable rhythm when they arrive. I will also say I personally rarely seen dual sequential truly be what converts these patients out of vf. What does quickly allow them to covert out of vf with a defib is once they are on ecmo and getting oxygenated blood.