beta-Blockers for the treatment of cardiac arrest from ventricular fibrillation?

More than 160,000 people suffer sudden cardiac death each year in the US. It is estimated that ventricular fibrillation (VF) is the initial rhythm in approximately 30% of these cases. Ventricular fibrillation that does not respond to the first few defibrillation attempts is associated with mortality rates of up to 97%. Currently, no pharmacological intervention has been shown to increase long-term survival in patients with shock-refractory VF. The purpose of this review article is to evaluate whether beta-blocker administration during the resuscitation of cardiac arrest from VF or pulseless ventricular tachycardia (VT) improves outcome. We searched the MEDLINE and EMBASE databases for human clinical trials, animal experimental trials, review articles, case reports and abstracts published between 1966 and September 2006. No human prospective randomized controlled trial has studied the effects of beta-blocker administration during VF directly. Prospective trials of anti-arrhythmics with beta-blocking properties have been published, as well as several case reports/case series and experimental animal studies. The evidence thus far suggests that beta-blockade during resuscitation from VF may be associated with increasing rates of resuscitation, greater post-resuscitation survival, and improved post-resuscitation myocardial function. These positive effects on outcome may be mediated by a decrease in the oxygen requirements of the fibrillating heart, thus improving the overall balance between myocardial oxygen supply and demand during resuscitation. While no significant detrimental effects directly related to low dose beta-blockade during VF have been reported in the studies reviewed, concerns relating to possible loss of myocardial contractility and hypotension remain. To this day, high quality human trials are lacking. Preliminary human studies are needed to assess the effects of beta-blockers in the treatment of cardiac arrest from ventricular fibrillation or pulseless VT further.