Association of prior beta-blocker treatment and outcome in patients with out-of-hospital cardiac arrest.
Clinical research in cardiology · 2026-06-22 · Observational study
Abstract
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with poor outcomes and presents a considerable treatment challenge. Here, we investigated the association of prior beta-blocker treatment with outcomes in patients with OHCA. METHODS: We enrolled consecutive OHCA patients with return of spontaneous circulation (ROSC). Beta-blocker plasma concentrations were measured upon admission and analyzed in relation to the number of defibrillations required to achieve ROSC, initial cardiac rhythm and in-hospital mortality. RESULTS: Among 207 enrolled patients (median age 68 years, 71% male, 45% shockable rhythm), 65 (31.4%) had detectable beta-blocker plasma concentrations. Detectable beta-blocker concentrations were not associated with the likelihood of an initial shockable rhythm (adjusted odds ratio [OR] 0.99 [95% confidence interval [CI], 0.52-1.91]; P = 0.99), number of defibrillations (adjusted incidence rate ratio 0.93 [95% CI 0.63-1.37], P = 0.72) or doses of epinephrine (adjusted mean 7.4 vs. 6.7 mg, P = 0.29) and amiodarone (adjusted mean 99.3 vs. 93.9 mg, P = 0.83) administered to achieve ROSC. When analyzed as a continuous variable, beta-blocker concentration on admission was not associated with in-hospital death (adjusted OR 0.85 [95% CI 0.67-1.08]; P = 0.18). However, patients with plasma concentrations above the median had lower odds of death compared to those with undetectable levels or those below the median (adjusted OR 0.36 [95% CI 0.13-0.96]; P = 0.042). CONCLUSION: In OHCA patients with ROSC, detectable beta-blocker plasma concentrations on admission were not associated with defibrillation requirements or initial cardiac rhythm. While any detectable beta-blocker level was not associated with overall mortality, levels above the median were associated with lower odds of death in this cohort. These results are hypothesis-generating and warrant confirmation in larger independent cohorts.