The Evolving Role of Esmolol in Management of Pre-Hospital Refractory Ventricular Fibrillation; a Scoping Review
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
7 January 2020
Introduction: Few studies have described their experience using esmolol, an ultra-short acting Î²-adrenergic antagonist, in the emergency department (ED) as a feasible adjuvant therapy for the treatment of refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) out-of-hospital cardiac arrest. However, there is currently insufficient evidence to support the widespread implementation of this therapy. The aim of this scoping review was to summarize the current available evidence on the use of esmolol as an adjuvant therapy for refractory VF/pVT out-of-hospital cardiac arrest, as well as to identify gaps within the literature that may require further research.
Methods: We conducted a comprehensive literature search of MEDLINE via PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) on July 5, 2019. The search was restricted to articles that were published from January 2000 to July 2019. Google Scholar was searched and reference lists of relevant papers were examined to identify additional studies. We included any controlled clinical study design (randomized controlled trials and non-randomized controlled trials) and observational studies (cohort studies and case-control studies) in adults providing information on the use of esmolol as an adjuvant therapy for refractory VF/pVT out-of-hospital cardiac arrest.
Results: The search yielded 2817 unique records, out of which 2 peer-reviewed articles were found relating to the research purpose totaling 66 patients 33.3% (n = 22) of which received esmolol. These studies found that sustained return of spontaneous circulation (ROSC) was significantly more common in the patients that received esmolol compared to the control group. However, no statistically significant outcomes were found regarding survival to discharge and favorable neurological outcome. No randomized controlled trials were identified.
Conclusion: To date, it is difficult to conclude the real benefit of esmolol as an adjuvant therapy for refractory VF/pVT out-of-hospital cardiac arrest based on the available evidence. The findings of this scoping review suggest that there is a paucity of research and limited evidence to support this therapy.
- Cardiopulmonary resuscitation
- out-of-hospital cardiac arrest
- ventricular fibrillation
How to Cite
Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146-e603.
Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statisticsâ€”2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18-e209.
Al-Khatib S, Stevenson W, Ackerman M, Bryant W, Callans D, Curtis A, et al. AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society [published online ahead of print October 30, 2017]. Heart Rhythm https://doi org/101016/j hrthm. 2017;35.
Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, et al. Part 7: adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18_suppl_2):S444-S64.
Koster RW, Walker RG, Chapman FW. Recurrent ventricular fibrillation during advanced life support care of patients with prehospital cardiac arrest. Resuscitation. 2008;78(3):252-7.
Sakai T, Iwami T, Tasaki O, Kawamura T, Hayashi Y, Rinka H, et al. Incidence and outcomes of out-of-hospital cardiac arrest with shock-resistant ventricular fibrillation: data from a large population-based cohort. Resuscitation. 2010;81(8):956-61.
Lybeck AM, Moy HP, Tan DK. Double sequential defibrillation for refractory ventricular fibrillation: a case report. Prehospital Emergency Care. 2015;19(4):554-7.
Ross EM, Redman TT, Harper SA, Mapp JG, Wampler DA, Miramontes DA. Dual defibrillation in out-of-hospital cardiac arrest: a retrospective cohort analysis. Resuscitation. 2016;106:14-7.
Emmerson AC, Whitbread M, Fothergill RT. Double sequential defibrillation therapy for out-of-hospital cardiac arrests: The London experience. Resuscitation. 2017;117:97-101.
Cheskes S, Wudwud A, Turner L, McLeod S, Summers J, Morrison LJ, et al. The impact of double sequential external defibrillation on termination of refractory ventricular fibrillation during out-of-hospital cardiac arrest. Resuscitation. 2019;139:275-81.
Beck LR, Ostermayer DG, Ponce JN, Srinivasan S, Wang HE. Effectiveness of prehospital dual sequential defibrillation for refractory ventricular fibrillation and ventricular tachycardia cardiac arrest. Prehospital Emergency Care. 2019;23(5):597-602.
Kagawa E, Dote K, Kato M, Sasaki S, Nakano Y, Kajikawa M, et al. Should we emergently revascularize occluded coronaries for cardiac arrest? Rapid-response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention. Circulation. 2012;126(13):1605-13.
Avalli L, Maggioni E, Formica F, Redaelli G, Migliari M, Scanziani M, et al. Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: an Italian tertiary care centre experience. Resuscitation. 2012;83(5):579-83.
Haneya A, Philipp A, Diez C, Schopka S, Bein T, Zimmermann M, et al. A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest. Resuscitation. 2012;83(11):1331-7.
Johnson NJ, Acker M, Hsu CH, Desai N, Vallabhajosyula P, Lazar S, et al. Extracorporeal life support as rescue strategy for out-of-hospital and emergency department cardiac arrest. Resuscitation. 2014;85(11):1527-32.
Sakamoto T, Morimura N, Nagao K, Asai Y, Yokota H, Nara S, et al. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study. Resuscitation. 2014;85(6):762-8.
Kim SJ, Jung JS, Park JH, Park JS, Hong YS, Lee SW. An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched study. Critical Care. 2014;18(5):535.
Stub D, Bernard S, Pellegrino V, Smith K, Walker T, Sheldrake J, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation. 2015;86:88-94.
Yannopoulos D, Bartos JA, Raveendran G, Conterato M, Frascone RJ, Trembley A, et al. Coronary artery disease in patients with out-of-hospital refractory ventricular fibrillation cardiac arrest. Journal of the American College of Cardiology. 2017;70(9):1109-17.
Yannopoulos D, Bartos JA, Martin C, Raveendran G, Missov E, Conterato M, et al. Minnesota resuscitation consortium's advanced perfusion and reperfusion cardiac life support strategy for outâ€ofâ€hospital refractory ventricular fibrillation. Journal of the American Heart Association. 2016;5(6):e003732.
Nademanee K, Taylor R, Bailey WE, Rieders DE, Kosar EM. Treating electrical storm: sympathetic blockade versus advanced cardiac life supportâ€“guided therapy. Circulation. 2000;102(7):742-7.
Killingsworth CR, Wei C-C, Dellâ€™Italia LJ, Ardell JL, Kingsley MA, Smith WM, et al. Short-acting Î²-adrenergic antagonist esmolol given at reperfusion improves survival after prolonged ventricular fibrillation. Circulation. 2004;109(20):2469-74.
de Oliveira FC, Feitosa-Filho GS, Ritt LEF. Use of beta-blockers for the treatment of cardiac arrest due to ventricular fibrillation/pulseless ventricular tachycardia: a systematic review. Resuscitation. 2012;83(6):674-83.
Driver BE, Debaty G, Plummer DW, Smith SW. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation. Resuscitation. 2014;85(10):1337-41.
Lee YH, Lee KJ, Min YH, Ahn HC, Sohn YD, Lee WW, et al. Refractory ventricular fibrillation treated with esmolol. Resuscitation. 2016;107:150-5.
Hwang CW, Gamble G, Marchick M, Becker TK. A case of refractory ventricular fibrillation successfully treated with low-dose esmolol. BMJ Case Reports CP. 2019;12(3):e228208.
Moher D, Schulz KF, Simera I, Altman DG. Guidance for developers of health research reporting guidelines. PLoS medicine. 2010;7(2).
Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005;8(1):19-32.
Mays N, Roberts E, Popay J. Synthesising research evidence. Studying the organisation and delivery of health services: Research methods. 2001;220.
Richards DA. The complex interventions framework. Complex interventions in health: Routledge; 2015. p. 27-41.
McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. Journal of clinical epidemiology. 2016;75:40-6.
Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of internal medicine. 2018;169(7):467-73.
Jacobs I, Nadkarni V, Arrest ITFoC, Outcomes CR, PARTICIPANTS C, Bahr J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004;110(21):3385-97.
Raina KD, Callaway C, Rittenberger JC, Holm MB. Neurological and functional status following cardiac arrest: method and tool utility. Resuscitation. 2008;79(2):249-56.
Rittenberger JC, Raina K, Holm MB, Kim YJ, Callaway CW. Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac arrest. Resuscitation. 2011;82(8):1036-40.
Hilwig RW, Kern KB, Berg RA, Sanders AB, Otto CW, Ewy GA. Catecholamines in cardiac arrest: role of alpha agonists, beta-adrenergic blockers and high-dose epinephrine. Resuscitation. 2000;47(2):203-8.
Gazmuri RJ, Becker J. Cardiac resuscitation: the search for hemodynamically more effective methods. Chest. 1997;111(3):712.
Tang W, Weil MH, Sun S, Noc M, Yang L, Gazmuri RlJ. Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation. 1995;92(10):3089-93.
Wiest DB, Haney JS. Clinical pharmacokinetics and therapeutic efficacy of esmolol. Clinical pharmacokinetics. 2012;51(6):347-56.
Bourque D, Daoust R, Huard V, Charneux M. Î²-Blockers for the treatment of cardiac arrest from ventricular fibrillation? Resuscitation. 2007;75(3):434-44.
Rubertsson S, Karlsten R. Increased cortical cerebral blood flow with LUCAS; a new device for mechanical chest compressions compared to standard external compressions during experimental cardiopulmonary resuscitation. Resuscitation. 2005;65(3):357-63.
- Abstract Viewed: 249 times
- PDF Downloaded: 528 times
- HTML Downloaded: 23 times