Safety and efficacy of beta-blockers to improve oxygenation in patients on veno-venous ECMO

Abstract

Purpose: Beta-blockers (BB) may improve oxygenation in patients on veno-venous extracorporeal membrane oxygenation (V-V ECMO). This study analyzed safety and efficacy of BB in hypoxemic patients on V-V ECMO.

Materials and methods: Retrospective analysis of patients who were treated with BB during V-V ECMO in two centers. The primary safety outcome was a composite of occurrence of bradycardia or hypotension with need for intervention, resuscitation, unexplained rise in serum lactate, and discontinuation of beta-blockers for other reasons than inefficacy or resolution on hypoxemia during the first 5 days of therapy. The main efficacy outcome was increase in oxygen saturation (SaO₂) within 12 h after start of BB.

Results: 33 patients received BB for 4 [3-7] days while on V-V ECMO. Fifteen episodes of adverse events occurred in 13 patients (39%); BB had to be discontinued in only one patient for sustained hypotension. In two other patients, doses were reduced or temporarily withheld due to bradycardia. There was an increase in SaO₂ from 92 [90-96]% to 96 [94-97]% at 12 h, with unchanged mean arterial pressure and norepinephrine doses.

Conclusions: In this study, use of BB in hypoxemic patients on V-V ECMO was safe and associated with a moderate increase in SaO₂.

Keywords: ARDS; Beta-blockers; Hypoxia; Veno-venous ECMO.