Treatment for beta-blocker poisoning: a systematic review

Area of Science:

• Toxicology
• Cardiology
• Emergency Medicine

Background:

• Beta-adrenoreceptor antagonist (beta-blocker) poisoning is a frequent overdose scenario associated with significant morbidity and mortality.
• Effective treatment strategies are crucial for managing patients experiencing beta-blocker toxicity.

Purpose of the Study:

• To systematically evaluate the efficacy of various treatments for beta-adrenoreceptor antagonist poisoning.
• To identify interventions associated with improved survival and hemodynamic parameters in beta-blocker overdose.

Main Methods:

• Comprehensive literature searches were conducted across MEDLINE, Embase, and CENTRAL databases up to November 2019.
• Two reviewers screened over 15,000 citations, selecting 141 articles for analysis.
• Primary outcomes assessed included mortality and improvement in hemodynamic parameters.

Main Results:

• High risk of bias was noted across all interventions evaluated.
• Catecholamines, vasopressors, high-dose insulin euglycemic therapy, and veno-arterial extracorporeal membrane oxygenation were associated with reduced mortality.
• Hemodynamic improvements were observed with catecholamines, vasopressin, and high-dose insulin therapy, though evidence quality is low.

Conclusions:

• While evidence quality is low, catecholamines, vasopressors, high-dose insulin, and VA-ECMO appear beneficial in beta-blocker poisoning.
• A graduated treatment approach is recommended, starting with fluids and vasopressors/inotropes, followed by insulin, and then VA-ECMO for refractory cases.
• Further high-quality research is needed to establish definitive treatment guidelines.