Effect of Ultrashort-Acting β-Blockers on Mortality in Patients With Sepsis With Persistent Tachycardia Despite Initial Resuscitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Review of 7 RCTs (n=613) reported significantly lower 28-day mortality with ultra-short acting β-blockers esmolol and landiolol vs placebo/no-intervention in patients with sepsis & septic shock (RR 0.68, 95% CI 0.54-0.85). Absolute risk reduction was 18.2% and NNT was 5.5.

SPS commentary:

Landiolol is an ultra short acting β1-superselective beta-blocker. It was developed by modifying the chemical structure of esmolol to produce a compound with a higher rate of cardioselectivity and a greater potency without increasing its duration of action. In comparison to other betablockers, landiolol has the shortest elimination half-life (3 to 4 minutes), ultra-rapid onset of effect (heart rate begins to decrease immediately after completion of administration), and predictable effectiveness with inactive metabolites (heart rate returns to baseline levels at 30 min after completion of landiolol hydrochloride administration). It was approved in the EU in 2016 for treatment of arrhythmias, including AF and atrial flutter. It was reported in August 2020·that AOP Orphan was planning to file for a UK for treatment of supraventricular tachycardia and for the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other circumstances where short-term control of the ventricular rate with a short acting agent is desirable, as well as non-compensatory sinus tachycardia where, in the physician judgement the rapid heart rate requires specific intervention.

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