Cite this post as:
Guest Author. EMCrit – Propranolol Versus Metoprolol for Treatment of Electrical Storm by Kristina Kipp PharmD. EMCrit Blog. Published on August 7, 2018. Accessed on May 3rd 2024. Available at [https://emcrit.org/emcrit/propranolol-versus-metoprolol-for-electrical-storm/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: August 7, 2018
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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very cool pod, Kristina. thank you. i wonder. in the ER, if we have a patient in ES, say witnessed VF arrest, and he had multiple shocks, dual defib, amiodurone, and then what ? (for refractory, or recurring VF/VT), and we dont have ECMO. i thought the consideration was esmolol (Loading dose 500ug/kg, infusion 0 – 100ug/kg/min). but then i heard that if one couldnt get esmolol stat (ie, stat, like its already in the PIXUS or ER, ) to consider lopressor, which is. but this study (although a somewhat different population, maybe) suggests propranolol is better. i need to… Read more »
Thank you Tom! Great question regarding esmolol- Esmolol demonstrated efficacy during ACLS with refractory VT/VF. After a patient with minimal CO receives multiple doses of epinephrine, the buildup of catecholamines occurs and ultimately refractory VT/VF. As you mentioned, electrical storm with ICD is a different patient population than refractory VT. I will still use esmolol in the setting of ACLS if the patient continues to bounce back into VT despite epinephrine and defibrillation. I am unsure if you can extrapolate the outcomes from this study to witnessed arrest with refractory VT/VF. Propranolol was shown to be superior secondary to its… Read more »
Is this a thing?
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Loperamide?
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