Podcast 588: Esmolol for Refractory Ventricular Fibrillation

<p><strong>Contributor: Ricky Dhaliwal, MD, JD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Ventricular Fibrillation (VF) is a potentially fatal cardiac arrhythmia; Refractory VF even more so</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Epinephrine stimulates alpha and beta receptors which increase sympathetic tone, thereby increasing cardiac oxygen demand and myocardial calcium levels which can cause new arrhythmias, particularly a problem during resuscitation</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Esmolol (or any beta blocker) can be used in VF refractory to defibrillation, epinephrine and amiodarone in a last-ditch effort.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Esmolol in the setting of epinephrine can help prevent some of these known effects from repeated beta stimulation</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Dosing esmolol for refractory VF: 500mcg/kg bolus, followed by drip (max typically 1000 mcg/kg/min)</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Esmolol is associated with improved mortality in ACLS care in refractory VF</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Long DA, Long B, April MD.</span> <a href= "https://pubmed.ncbi.nlm.nih.gov/32192760/"><span style= "font-weight: 400;">Does β-Blockade for Treatment of Refractory Ventricular Fibrillation or Pulseless Ventricular Tachycardia Improve Outcomes?</span></a><span style= "font-weight: 400;">.</span> <em><span style= "font-weight: 400;">Ann Emerg Med</span></em><span style= "font-weight: 400;">. 2020;76(1):42-45. doi:10.1016/j.annemergmed.2020.01.025</span></span></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Lee YH, Lee KJ, Min YH, et al.</span> <a href= "https://pubmed.ncbi.nlm.nih.gov/27523955/"><span st