The first case series analysis on efficacy of esmolol injection for in-hospital cardiac arrest patients with refractory shockable rhythms in China.

Autor:	Lian R; Emergency Department, China-Japan Friendship Hospital, Beijing, China., Zhang G; General Surgery Department, China-Japan Friendship Hospital, Beijing, China., Yan S; Emergency Department, China-Japan Friendship Hospital, Beijing, China., Sun L; Emergency Department, China-Japan Friendship Hospital, Beijing, China., Gao W; Emergency Department, China-Japan Friendship Hospital, Beijing, China., Yang J; Emergency Department, China-Japan Friendship Hospital, Beijing, China., Li G; Emergency Department, China-Japan Friendship Hospital, Beijing, China., Huang R; Cardiac Care Unit, The First Affiliated Hospital of Dalian Medical University, Dalian, China., Wang X; Cardiac Care Unit, The First Affiliated Hospital of Dalian Medical University, Dalian, China., Liu R; Intensive Care Unit, Zhejiang Provincial People's Hospital, Hangzhou, China., Cao G; Cardiac Surgery Department, Qilu Hospital of ShanDong University, Jinan, China., Wang Y; Cardiac Care Unit, XiangTan Central Hospital, Xiangtan, China., Zhang G; Emergency Department, China-Japan Friendship Hospital, Beijing, China.
Jazyk:	angličtina
Zdroj:	Frontiers in pharmacology [Front Pharmacol] 2022 Sep 30; Vol. 13, pp. 930245. Date of Electronic Publication: 2022 Sep 30 (Print Publication: 2022).
DOI:	10.3389/fphar.2022.930245
Abstrakt:	Background: This study assessed the effects of esmolol injection in patients with in-hospital cardiac arrest (IHCA) with refractory ventricular fibrillation (VF)/pulseless ventricular tachycardia (pVT). Methods: From January 2018 to December 2021, 29 patients with IHCA with refractory shockable rhythm were retrospectively reviewed. Esmolol was administered after advanced cardiovascular life support (ACLS)-directed procedures, and outcomes were assessed. Results: Among the 29 cases, the rates of sustained return of spontaneous circulation (ROSC), 24-h ROSC, and 72-h ROSC were 79%, 62%, and 59%, respectively. Of those patients, 59% ultimately survived to discharge. Four patients with cardiac insufficiency died. The duration from CA to esmolol infusion was significantly shorter for patients in the survival group (SG) than for patients in the dead group (DG) (12 min, IQR: 8.5-19.5 vs. 23.5 min, IQR: 14.4-27 min; p = 0.013). Of those patients, 76% (22 of 29) started esmolol administration after the second dose of amiodarone. No significant difference was observed in the survival rate between this group and groups administered an esmolol bolus simultaneously or before the second dose of amiodarone (43% vs. 64%, p = 0.403). Of those patients, 31% (9 of 29) were administered an esmolol bolus for defibrillation attempts ≤ 5, while the remaining 69% of patients received an esmolol injection after the fifth defibrillation attempt. No significant differences were observed in the rates of ≥ 24-h ROSC (67% vs. 60%, p = 0.73), ≥ 72-h ROSC (67% vs. 55%, p = 0.56), and survival to hospital discharge (67% vs. 55%, p = 0.56) between the groups administered an esmolol bolus for defibrillation attempts ≤ 5 and defibrillation attempts > 5. Conclusion: IHCA patients with refractory shockable rhythms receiving esmolol bolus exhibited a high chance of sustained ROSC and survival to hospital discharge. Patients with end-stage heart failure tended to have attenuated benefits from beta-blockers. Further large-scale, prospective studies are necessary to determine the effects of esmolol in patients with IHCA with refractory shockable rhythms. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Lian, Zhang, Yan, Sun, Gao, Yang, Li, Huang, Wang, Liu, Cao, Wang and Zhang.)
Databáze:	MEDLINE
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