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
Answer
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).
References
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]
Lee YH, Lee KJ, Min YH, et al. Refractory ventricular fibrillation treated with esmolol. Resuscitation 2016; 107:150-5. [PMID 27523955]
