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

Bunge, Jeroen J H; Diaby, Soufiane; Valle, Ana L.; Bakker, Jan; Gommers, Diederik; Vincent, Jean‐Louis; Créteur, Jacques; Taccone, Fabio Silvio; Miranda, Dinis Reis

doi:10.1016/j.jcrc.2019.06.024

Cited by 22 publications

(22 citation statements)

References 20 publications

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“…b-blockers are generally contraindicated or administered with caution in patients with respiratory diseases because of the risk of bronchospasm [32]. It is interesting to note that esmolol was associated with an increase in stroke volume, maintenance of mean arterial pressure, and reduced the norepinephrine requirements in patients with septic shock [30], and a recent study revealed that administration of b-blockers improved oxygen saturation without affecting the mean arterial pressure or an increase in norepinephrine doses in patients on veno-venous extracorporeal membrane oxygenation [33]. Changes in hemodynamic factors were not assessed in our study, so future studies may need to evaluate the impact of landiolol on these factors in patients with septic shock and improve the prognosis of patients with ARDS.…”

Section: Discussionmentioning

confidence: 99%

Impact of patient characteristics on the efficacy and safety of landiolol in patients with sepsis-related tachyarrhythmia: Subanalysis of the J-Land 3S randomised controlled study

et al. 2020

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Background The J-Land 3S trial demonstrated that landiolol is effective and tolerated for treating sepsis-related tachyarrhythmias. Patient characteristics (e.g. baseline heart rate [HR], type of tachyarrhythmia, and concomitant disorders) may impact the outcomes of landiolol therapy. We performed subanalyses of J-Land 3S to evaluate the impact of patient characteristics on the efficacy and safety of landiolol for treating sepsis-related tachyarrhythmia. Methods Patients (≥20 years old; N = 151) hospitalised with sepsis at 54 participating hospitals in Japan with HR ≥100 beats/min for ≥10 min accompanied by diagnosis of tachyarrhythmia were randomised 1:1 to conventional sepsis therapy alone (control group) or conventional sepsis therapy plus landiolol (landiolol group). The efficacy and safety of landiolol were assessed in prespecified analyses of patients divided into subgroups by baseline characteristics and in post hoc, multivariate analyses with adjustment for age and HR at baseline. Findings The percentage of patients with HR of 60–94 beats/min at 24 h after randomisation (primary endpoint) was greater in the landiolol group in most subgroups in univariate unadjusted analyses and in multivariate logistic regression. The incidence of new-onset arrhythmia by 168 h and mortality by 28 days were also lower in the landiolol group in most subgroups in univariate and multivariate Cox proportional hazards models. No subgroups showed a markedly higher incidence of adverse events in univariate or multivariate logistic regression analyses. Interpretation These results of the J-Land 3S study suggest that the efficacy and safety of landiolol are generally unaffected by key patient characteristics. Funding Ono Pharmaceutical Co., Ltd.

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Section: Discussionmentioning

confidence: 99%

Impact of patient characteristics on the efficacy and safety of landiolol in patients with sepsis-related tachyarrhythmia: Subanalysis of the J-Land 3S randomised controlled study

et al. 2020

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“…Beta‐adrenergic blockers have been shown to improve the oxygenation level in the patients who were on ECMO. [ 66 ] This suggests the possibility that the use of beta‐adrenergic blockers in COVID‐19 patients who are on ECMO may improve the oxygenation level. It has been shown that beta‐adrenergic blockers improved the oxygenation level in the hypoxic condition induced in an animal study.…”

Section: Beta‐adrenergic Blocker Treatment In Covid‐19: How They Workmentioning

confidence: 99%

Beta‐Adrenergic Blockers as a Potential Treatment for COVID‐19 Patients

Vasanthakumar

2020

BioEssays

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More than 15 million people have been affected by coronavirus disease 2019 (COVID-19) and it has caused 640 016 deaths as of July 26, 2020. Currently, no effective treatment option is available for COVID-19 patients. Though many drugs have been proposed, none of them has shown particular efficacy in clinical trials. In this article, the relationship between the Adrenergic system and the renin-angiotensin-aldosterone system (RAAS) is focused in COVID-19 and a vicious circle consisting of the Adrenergic system-RAAS-Angiotensin converting enzyme 2 (ACE2)-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (which is referred to as the "ARAS loop") is proposed. Hyperactivation of the ARAS loop may be the underlying pathophysiological mechanism in COVID-19, and beta-adrenergic blockers are proposed as a potential treatment option. Beta-adrenergic blockers may decrease the SARS-CoV-2 cellular entry by decreasing ACE2 receptors expression and cluster of differentiation 147 (CD147) in various cells in the body. Beta-adrenergic blockers may decrease the morbidity and mortality in COVID-19 patients by preventing or reducing acute respiratory distress syndrome (ARDS) and other complications. Retrospective and prospective clinical trials should be conducted to check the validity of the hypothesis. Also see the video abstract here https://youtu.be/uLoy7do5ROo.

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“…In COVID-19 patients on extracorporeal membrane oxygenation (ECMO), beta-blockers may improve the oxygenation level. A study by Bunge et al[ 20 ] reported use of beta-blockers, using primarily metoprolol, in patients with hypoxemia on V-V ECMO was safe and associated with a moderate increase in SaO2. In patients with hyperdynamic circulation, beta-blockers may reduce the amount of blood that the extracorporeal membrane would not oxygenate, reduce the intra-pulmonary shunt, andyield some myocardial protection.…”

Section: Authors' Contributionsmentioning

confidence: 99%

“…In patients with hyperdynamic circulation, beta-blockers may reduce the amount of blood that the extracorporeal membrane would not oxygenate, reduce the intra-pulmonary shunt, andyield some myocardial protection. [ 20 ].…”

Section: Authors' Contributionsmentioning

confidence: 99%

Hypertension and COVID-19: Potential use of beta-blockers and a call for randomized evidence

Alsagaff¹,

Mulia²

2021

Indian Heart Journal

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

Cited by 22 publications

References 20 publications

Impact of patient characteristics on the efficacy and safety of landiolol in patients with sepsis-related tachyarrhythmia: Subanalysis of the J-Land 3S randomised controlled study

Impact of patient characteristics on the efficacy and safety of landiolol in patients with sepsis-related tachyarrhythmia: Subanalysis of the J-Land 3S randomised controlled study

Beta‐Adrenergic Blockers as a Potential Treatment for COVID‐19 Patients

Hypertension and COVID-19: Potential use of beta-blockers and a call for randomized evidence

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