Beta-blockers safe for use in ECMO patients
The use of beta-blockers in hypoxaemic patients receiving veno-venous extracorporeal membrane oxygenation (V–V ECMO) safely and modestly increases oxygen saturation, a recent study has found.
Researchers retrospectively examined 33 patients (median age, 49 years; 55 percent male) who received beta-blockers for a median of 4 days while on V–V ECMO. The primary safety outcome was the occurrence of a composite of bradycardia or hypotension requiring intervention, as well as the need for resuscitation, the discontinuation of beta-blockers during the first 5 days and an unexplained spike in serum lactate.
A total of 15 safety events in 13 patients (39 percent) were reported. Majority (n=9) required an increase in norepinephrine dose though only one had to discontinue beta-blocker medication. Other safety endpoints included bradycardia with need for intervention (n=2), new rise in lactate levels (n=2), new septic shock (n=1) and the risk of adverse drug interactions (n=1).
In terms of efficacy, there was a significant increase in oxygen saturation in the first 12 hours after beta-blocker initiation (92 percent to 96 percent; p=0.01) accompanied by a decrease in heart rate (105 to 93 bpm; p<0.01). There were no such changes in lactate levels, norepinephrine dose and mean arterial pressure.
“In our experience, [beta-blocker] therapy was well tolerated and resulted in a significant increase in arterial oxygenation in patients on V-V ECMO,” said researchers. “Future prospective studies should be performed to clarify the benefit of this strategy in this setting.”