Use of beta-blockers for the treatment of cardiac arrest due to ventricular fibrillation/pulseless ventricular tachycardia: a systematic review.
BACKGROUND
Advanced Life Support guidelines recommend the use of epinephrine during Cardiopulmonary Resuscitation (CPR), as to increase coronary blood flow and perfusion pressure through its alpha-adrenergic peripheral vasoconstriction, allowing minimal rises in coronary perfusion pressure to make defibrillation possible. Contrasting to these alpha-adrenergic effects, epinephrine's beta-stimulation may have deleterious effects through an increase in myocardial oxygen consumption and a reduction of subendocardial perfusion, leading to postresuscitation cardiac dysfunction.


OBJECTIVE
The present paper consists of a systematic review of the literature regarding the use of beta-blockade in cardiac arrest due to ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT).


METHODS
Studies were identified through MEDLINE electronic databases research and were included those regarding the use of beta-blockade during CPR.


RESULTS
Beta-blockade has been extensively studied in animal models of CPR. These studies not only suggest that beta-blockade could reduce myocardial oxygen requirements and the number of shocks necessary for defibrillation, but also improve postresuscitation myocardial function, diminish arrhythmia recurrences and prolong survival. A few case reports described successful beta-blockade use in patients, along with two prospective human studies, suggesting that it could be safe and effectively used during cardiac arrest in humans.


CONCLUSIONS
Even though the existing literature points toward a beneficial effect of beta-blockade in patients presenting with cardiac arrest due to VF/pulseless VT, high quality human trials are still lacking to answer this question definitely.
Escola Bahiana de Medicina e Saúde Pública, Rua Frei Henrique, n° 08, Nazaré, CEP: 40050-420, Salvador, BA, Brazil.
Felipe Carvalho
FC
de Oliveira
Gilson Soares
GS
Feitosa-Filho
Luiz Eduardo Fonteles
LE
Ritt
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000818:Animals; D016887:Cardiopulmonary Resuscitation; D003326:Coronary Circulation; D004837:Epinephrine / Q000627:therapeutic use*; D006323:Heart Arrest / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D009206:Myocardium / Q000378:metabolism; D010101:Oxygen Consumption / Q000187:drug effects; D011412:Propanolamines / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000188:drug therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use; D014693:Ventricular Fibrillation / Q000150:complications* / Q000188:drug therapy
D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D011433:Propranolol; C036604:esmolol; D004837:Epinephrine