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

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