Abstract
Background
Refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT)
refers to cases that do not respond to traditional Advanced Cardiac Life Support measures
and are associated with significantly lower survival rates. Beta-blockade may improve
outcomes by protecting against the deleterious effects associated with epinephrine’s
beta-receptor effect.
Objective
This systematic review and meta-analysis aimed to evaluate whether beta-blockade compared
with control improved outcomes among patients in cardiac arrest due to refractory
VF/VT.
Methods
PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies
of selected articles were assessed on September 2nd, 2019 for all studies evaluating
beta-blockade versus control groups in patients with cardiac arrest due to refractory
VF/VT. PRISMA guidelines were followed. Data were dual extracted into a predefined
worksheet and quality analysis was performed with the Cochrane Risk of Bias in Non-randomised
Studies of Interventions tool. Data were summarized and a meta-analysis was performed
assessing temporary and sustained return of spontaneous circulation (ROSC), survival-to-admission,
survival-to-discharge, and survival with a favorable neurologic outcome.
Results
Three studies (n = 115 patients) were selected for final inclusion. Beta-blockade
was associated with an increased rate of temporary ROSC (OR 14.46; 95% CI 3.63–57.57),
sustained ROSC (OR 5.76; 95% CI 1.79–18.52), survival-to-admission (OR 5.76; 95% CI
1.79–18.52), survival-to-discharge (OR 7.92; 95% CI 1.85–33.89), and survival with
a favorable neurologic outcome (OR 4.42; 95% CI 1.05–18.56). Overall risk of bias
ranged from moderate-to-severe, which was primarily influenced by selection of participants
and potential confounding. This study was registered with PROSPERO (CRD42019126902).
Conclusions
The data suggest that beta-blockade may be associated with improved outcomes ranging
from ROSC to survival with a favorable neurologic outcome. Future randomized controlled
trials are needed to further evaluate this intervention in refractory VF/VT.
Keywords
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Article info
Publication history
Published online: November 29, 2019
Accepted:
November 20,
2019
Received in revised form:
November 8,
2019
Received:
July 30,
2019
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2019 Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Data for beta-blockade in ACLS — A trial sequential analysisResuscitationVol. 150
- PreviewThe Advanced Cardiac Life Support algorithm for ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) includes adrenaline (epinephrine).1 Through its peripherally vasoconstrictive alpha-adrenergic effect, blood flow is redirected centrally, improving coronary perfusion. Adrenaline’s beta-adrenergic effect however, may be harmful. It increases myocardial sensitivity to arrhythmias, potentially leading to cardiovascular collapse from refractory pVT/VF.2,3 Therefore, there is a need to investigate potential therapies that may counteract adrenaline’s deleterious effects.
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