Tuesday, January 13, 2015

Esmolol for cardiac arrest?

From a paper in Resuscitation:

90 patients had CA with an initial rhythm of VF or VT; 65 patients were excluded, leaving 25 for analysis. Six patients received esmolol during cardiac arrest, and nineteen did not. All patients had ventricular dysrhythmias refractory to many defibrillation attempts, including defibrillation after administration of standard ACLS medications. Most received high doses of adrenaline, amiodarone, and sodium bicarbonate. Comparing the patients that received esmolol to those that did not: 67% and 42% had temporary return of spontaneous circulation (ROSC); 67% and 32% had sustained ROSC; 66% and 32% survived to intensive care unit admission; 50% and 16% survived to hospital discharge; and 50% and 11% survived to discharge with a favorable neurologic outcome, respectively.

Beta-blockade should be considered in patients with RVF in the ED prior to cessation of resuscitative efforts.

This is a very small study that would not ordinarily be practice changing but if you're at the point of calling a code for a patient who is still in VF why not? The folks at Academic Life in Emercency Medicine seem to agree.

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