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Beta-blockers for Refractory V-fib or V-tach?

August 5, 2020

Written by Clay Smith

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Beta-blockers may improve ROSC and survival with favorable neurological outcome in patients with refractory v-fib or pulseless v-tach.

Why does this matter?
There is a whole lot of sympathetic tone during cardiac arrest, then we give epinephrine. That can lead to myocardial oxygen consumption and make the cells more electrically unstable. Would a beta-blocker help mitigate some of these effects?

Beta-blockers in an unusual role
This was a rapid review of a previous meta-analysis. Three studies looked at beta-blocker use for refractory v-fib/pulseless v-tach. Two were relevant to this analysis and found that for the most important outcome, survival with favorable neurological outcome, use of beta-blockers markedly improved the odds, OR 4.42 (95%CI 1.05–18.56). It also improved overall survival and ROSC. After 3 shocks and no improvement, why not? The two included studies used esmolol. Keep in mind, the sample size was a combined 66 patients. The overall certainty of evidence was very low. But it seems like this is worth a try, in my mind.

Does β-Blockade for Treatment of Refractory Ventricular Fibrillation or Pulseless Ventricular Tachycardia Improve Outcomes? Ann Emerg Med. 2020 Jul;76(1):42-45. doi: 10.1016/j.annemergmed.2020.01.025. Epub 2020 Mar 16.

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