title: Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation.
abstract: BACKGROUND
  We compare the outcomes for patients who received esmolol to those who did not receive esmolol during refractory ventricular fibrillation (RVF) in the emergency department (ED).
  
  
  METHODS
  A retrospective investigation in an urban academic ED of patients between January 2011 and January 2014 of patients with out-of-hospital or ED cardiac arrest (CA) with an initial rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT) who received at least three defibrillation attempts, 300mg of amiodarone, and 3mg of adrenaline, and who remained in CA upon ED arrival. Patients who received esmolol during CA were compared to those who did not.
  
  
  RESULTS
  90 patients had CA with an initial rhythm of VF or VT; 65 patients were excluded, leaving 25 for analysis. Six patients received esmolol during cardiac arrest, and nineteen did not. All patients had ventricular dysrhythmias refractory to many defibrillation attempts, including defibrillation after administration of standard ACLS medications. Most received high doses of adrenaline, amiodarone, and sodium bicarbonate. Comparing the patients that received esmolol to those that did not: 67% and 42% had temporary return of spontaneous circulation (ROSC); 67% and 32% had sustained ROSC; 66% and 32% survived to intensive care unit admission; 50% and 16% survived to hospital discharge; and 50% and 11% survived to discharge with a favorable neurologic outcome, respectively.
  
  
  CONCLUSIONS
  Beta-blockade should be considered in patients with RVF in the ED prior to cessation of resuscitative efforts.
authors.affiliation: Hennepin County Medical Center, Department of Emergency Medicine, 701 Park Ave S, MC 825, Minneapolis, MN 55415, USA. Electronic address: briandriver@gmail.com.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Driver
authors.affiliation: Hennepin County Medical Center, Department of Emergency Medicine, 701 Park Ave S, MC 825, Minneapolis, MN 55415, USA; University of Minnesota, Department of Medicine-Cardiovascular Division, Mayo Mail Code 508, 420 Delaware Street SE, Minneapolis, MN 55455, USA; UJF-Grenoble 1/CNRS/CHU de Grenoble/TIMC-IMAG UMR 5525, Grenoble, F-38041, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Debaty
authors.affiliation: Hennepin County Medical Center, Department of Emergency Medicine, 701 Park Ave S, MC 825, Minneapolis, MN 55415, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Plummer
authors.affiliation: Hennepin County Medical Center, Department of Emergency Medicine, 701 Park Ave S, MC 825, Minneapolis, MN 55415, USA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Smith
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use*; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use*; D012189:Retrospective Studies; D017211:Treatment Failure; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D011412:Propanolamines; C036604:esmolol
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Defibrillation