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Background <p>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.</p> Methods <p>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.</p> Results <p>Among 207 enrolled patients (median age 68&#xa0;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]; <i>P</i> = 0.99), number of defibrillations (adjusted incidence rate ratio 0.93 [95% CI 0.63–1.37], <i>P</i> = 0.72) or doses of epinephrine (adjusted mean 7.4 vs. 6.7&#xa0;mg, <i>P</i> = 0.29) and amiodarone (adjusted mean 99.3 vs. 93.9&#xa0;mg, <i>P</i> = 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]; <i>P</i> = 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]; <i>P</i> = 0.042).</p> Conclusion <p>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.</p> Graphical Abstract <p></p>

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Association of prior beta-blocker treatment and outcome in patients with out-of-hospital cardiac arrest

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月22日

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  • Fardin Hamidi,
  • Fabian Muhler,
  • Gisela Skopp,
  • Jonas Rusnak,
  • Claudius Speer,
  • Guido Michels,
  • Norbert Frey,
  • Thomas A. Zelniker,
  • Michael R. Preusch

摘要

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.

Graphical Abstract