From the Research
Beta blockers should generally be continued during targeted temperature management (TTM) after cardiac arrest, unless the patient develops significant bradycardia, hypotension, or signs of cardiogenic shock. The decision to continue or hold beta blockers during TTM should be based on the patient's individual hemodynamic status and underlying cardiac condition. Common beta blockers used include metoprolol, carvedilol, and atenolol at their standard dosing, which help control heart rate and blood pressure, reducing myocardial oxygen demand and preventing arrhythmias 1. However, if the patient develops significant bradycardia (heart rate below 50 beats per minute), hypotension (systolic blood pressure below 90 mmHg), or signs of cardiogenic shock, beta blockers should be temporarily held. The rationale for continuing beta blockers during TTM is that they provide cardioprotection and potentially improve neurological outcomes, while also mitigating the increased sympathetic tone and catecholamine surge that occurs during rewarming 2. Once the patient is stabilized and rewarmed, beta blockers can be restarted or titrated as needed based on the patient's hemodynamic status and underlying cardiac condition. It is essential to note that the doses of beta blockers used in clinical practice are often less than the recommended target doses, and little up-titration occurs in the first 60 to 90 days after hospital discharge 3. Therefore, careful monitoring and adjustment of beta blocker doses are crucial to ensure optimal treatment and minimize potential adverse effects. In general, the combination of beta-blockers and other antihypertensive agents, such as ACE inhibitors, can provide effective blood pressure lowering and improved cardiovascular outcomes 1. However, the specific treatment approach should be individualized based on the patient's unique clinical profile and medical history.