UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Esmolol in refractory ventricular fibrillation

Keywords: esmolol, ventricular fibrillation, cardiac arrest (PubMed Search)

Posted: 11/21/2016 by Michelle Hines, PharmD (Emailed: 12/3/2016) (Updated: 12/3/2016)
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Consider esmolol IV 500 mcg/kg loading dose followed by a continuous infusion of 0-100 mcg/kg/min for patients in refractory ventricular fibrillation 


  • Two small, retrospective studies have described increased rates of sustained return of spontaneous circulation (ROSC) in patients with refractory ventricular fibrillation who received esmolol IV 500 mcg/kg loading dose followed by 0-100 mcg/kg/min continuous infusion.
  • In both studies, refractory ventricular fibrillation was defined as ventricular fibrillation that was resistant to ≥3 defibrillations, 3 mg epinephrine, and 300 mg amiodarone.
  • The study by Driver, et al reports that 4 of 6 (67%) patients who received esmolol, compared to 6 of 19 who did not receive esmolol, achieved sustained ROSC.
  • In the study by Lee, et al, sustained ROSC was significantly more common in patients who received esmolol (9/15 (56%)) than those who did not receive esmolol (4/25 (16%)) (p=0.007).


  1. Driver BE, Debaty G, Plummer DW, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation. Resuscitation 2014; 85:1337-41. [PMID 25033747]
  2. Lee YH, Lee KJ, Min YH, et al. Refractory ventricular fibrillation treated with esmolol. Resuscitation 2016; 107:150-5. [PMID 27523955]

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