Esmolol

Aliases: Brevibloc  

Indications: Refractory Ventricular Fibrillation or Pulseless Ventricular Tachycardia     

Contraindications: None in Cardiac Arrest   

Concentrations: 

Injection: 10 mg/mL

Dosing

Adult:

Indication Dose Route Note 
Refractory VF/pVT1st dose: 0.5 mg/kg
(Max:10 mg)
2nd dose: 0.05-0.1 mg/kg/min
Increase by 0.025mg/kg/min
every 5 minutes		IV

IV Infusion

-Give after 3mg of
Epinephrine and
450mg Amiodarone
-Stop infusion for
ROSC/PEA/Asystole

Pediatric:

Indication Dose Route Note 
None

Precautions: FDA pregnancy category C  

Adverse/Side Effects: Pulmonary edema, AV Block, Bradycardia, Skin/Tissue Necrosis, Bronchospasm, Seizures, Hypotension 

Class: Beta1-selective adrenergic antagonists  

Mechanism of Action: The antiarrhythmic properties of esmolol occur at the nodal level of pacemaker control, increasing sinus cycle length and sinus node recovery time and slowing conduction through the AV node. The pharmacodynamic consequence of this activity is a negative chronotropic effect and, occasionally, conversion to sinus rhythm in the case of atrial fibrillation and/or flutter. 

Onset of ActionPeak EffectDuration of Action 
Rapid5 minutes20 minutes