Feasibility of prehospital esmolol for refractory ventricular fibrillation.
Journal of the American College of Emergency Physicians Open · 2022-04-01 · Quasi-experimental
Abstract
BACKGROUND: Esmolol may increase survival for patients with refractory ventricular fibrillation (RVF); however, information related to esmolol use in the prehospital environment is limited. We aimed to assess the feasibility of prehospital bolus dose esmolol for patients with RVF treated by a high-volume, ground-based emergency medical services (EMS) agency. METHODS: Esmolol (0.5 mg/kg single bolus) was added to the RVF protocol on December 10, 2018. Feasibility was defined as esmolol administration in >75% of RVF cases. Secondarily, we compared the proportion of patients with prehospital return of spontaneous circulation (ROSC), 24-hour survival, and survival to hospital discharge during the intervention period (December 10, 2018-June 10, 2020) to a historical control period (June 10, 2017-December 9, 2018) using chi-square tests. RESULTS: Before the protocol change, 63 patients with RVF were identified. After esmolol was added, 70 patients with RVF were identified and 61 (87%) received esmolol. Prehospital ROSC was higher in the esmolol group compared to the historical control group, though statistical significance was not reached (38% versus 24%, P = 0.09). Overall, few patients survived to 24 hours (esmolol n = 15, pre-esmolol n = 16) and fewer survived to hospital discharge (esmolol n = 5, pre-esmolol n = 5), precluding stable statistical comparisons. CONCLUSION: Collectively, these findings suggest that EMS clinicians are able to accurately identify RVF and administer esmolol in the prehospital setting and that ROSC may be increased. Further large-scale studies are needed to determine the effect of prehospital esmolol for RVF as it relates to neurologically intact hospital discharge.