The following is a summary of “Esmolol, vector change, and dose-capped epinephrine for prehospital ventricular fibrillation or pulseless ventricular tachycardia,” published in the November 2022 issue of Emergency Medicine by Stupca, et al.


A subpopulation of patients with refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) cardiac arrest are those who do not respond to traditional Advanced Cardiac Life Support (ACLS) procedures and have poor prognoses. Although there was little proof, administering esmolol and performing vector change defibrillation have both shown promise in improving outcomes for these individuals. For a study, researchers sought to compare the clinical outcomes of patients with prehospital refractory VF/pVT who received an Emergency Medical Service (EMS) bundle, which included esmolol administration, vector change defibrillation, and dose-capped epinephrine at 3 mg, to patients who received standard ACLS interventions.

Medical data between October 18, 2017, and March 15, 2022, were examined in the multicenter, retrospective cohort investigation. Patients who had a prehospital cardiac arrest with the rhythms VF or pVT, had received at least 3 conventional defibrillations, at least 3 mg of epinephrine, and at least 300 mg of amiodarone, were eligible to participate. Before its deployment, patients who got standard ACLS procedures were contrasted with those who received the EMS package. The main result was sustained return of spontaneous circulation (ROSC), which was determined as ROSC continuing for 20 minutes without a subsequent cardiac arrest. Secondary outcomes were the frequency of any ROSC, survival to hospital arrival, survival at discharge, and neurologically intact survival at discharge.

In all, 83 participants were included in the trial. 46 patients made up the pre-EMS bundle group, while 47 patients made up the post-EMS bundle group. Pre-EMS bundle patients experienced substantially higher rates of sustained ROSC (58.3% vs. 17%, P< 0.001), any ROSC (66.7% vs 19.1%, P< 0.001), and survival to hospital arrival (55.6% vs. 17%, P< 0.001). At hospital release, the rates of neurologically intact survival (5.9% vs. 4.3%, P = 1.00) and survival to hospital discharge (16.7% vs. 6.4%, P = 0.17) did not differ substantially between the groups.

When they arrived at the hospital, patients who got the EMS bundle were much less likely to have persistent ROSC and pulses. The frequency of neurologically unharmed survivors was modest and comparable between groups.

Reference: sciencedirect.com/science/article/pii/S073567572200715X