Intravenous Lipid Emulsion in Beta-Blocker With or Without Calcium Channel Blocker Toxicity: A Systematic Review of...

Severe beta-blocker (BB) poisoning, with or without calcium channel blocker (CCB) co-ingestion, can cause refractory cardiovascular collapse and mortality. Intravenous lipid emulsion (ILE) has been used as a rescue therapy in selected severe cases, although its definitive clinical role remains uncertain. This systematic review summarizes published human case reports and case series describing ILE administration in BB with or without CCB toxicity. Databases including Medline, PubMed, EMBASE, and Google Scholar were searched from inception to December 31, 2024. Patient characteristics, poisoning details, pre-ILE clinical status, co-interventions, ILE dosing, hemodynamic and neurologic responses, and outcomes were extracted and analyzed using non-parametric methods. Twenty-two studies including 28 cases were identified, comprising 15 cases of isolated BB toxicity and 13 cases of combined BB and CCB toxicity. ILE was administered mainly as a rescue intervention for cardiovascular collapse or cardiac arrest; 17 patients (60.7%) were intubated and 10 (35.7%) required cardiopulmonary resuscitation before ILE administration. Hemodynamic improvement after ILE was reported in 21 cases (75.0%), and five patients died, corresponding to an overall mortality rate of 17.9%. Favorable discharge status was significantly associated with the absence of pre-ILE cardiopulmonary resuscitation, post-ILE clinical improvement, and blood pressure improvement after ILE. No significant association was observed between cumulative ILE dosage and clinical outcomes. Although these findings are limited by case-level evidence, publication bias, and confounding co-interventions, they support continued consideration of ILE as a last-resort rescue therapy in selected life-threatening BB/CCB poisonings rather than routine early intervention.