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Original Articles
CPR/Resuscitation
Esmolol in the management of refractory ventricular fibrillation: a systematic review and meta-analysis
Kathleen Lau, Yau-Lam Alex Chau, Ting-An Cheng, Michael Lai, David Seonguk Yeom, Ursula Ellis, Anthony Lau
Received June 1, 2025  Accepted May 27, 2026  Published online August 19, 2026  
DOI: https://doi.org/10.4266/acc.001675    [Epub ahead of print]
  • 23 View
  • 2 Download
AbstractAbstract PDFSupplementary Material
Background
Refractory ventricular fibrillation (rVF) presents a significant challenge in advanced cardiovascular life support (ACLS), with traditional antiarrhythmics showing limited success in improving long-term survival and neurological function. Esmolol, a beta-1 selective adrenergic receptor antagonist, might offer benefits due to its rapid onset and catecholamine-suppressing effects during cardiac arrest.
Methods
This systematic review and meta-analysis (SRMA) evaluates the effectiveness of esmolol in improving the temporary return of spontaneous circulation (ROSC), sustained ROSC, survival to discharge, and survival to discharge with favorable neurological outcomes in rVF patients. This SRMA reviewed Medline (Ovid), Embase (Ovid), and Cochrane Central (Ovid) from their inception until October 2, 2025, for full-text clinical or observational studies assessing esmolol use alongside standard ACLS in adult rVF in both prehospital and in-hospital settings.
Results
The risk of bias was independently assessed using the Newcastle-Ottawa Scale. Pooled risk ratios (RRs; 95% CI) are reported. Analyses in which I² >50% used a random-effects model; otherwise, a common-effect model was used. Four studies (n=273) are included. Esmolol was associated with an increased temporary ROSC (RR, 1.80; 95% CI, 1.09–2.98), and although the links were not statistically significant, esmolol trended toward a benefit in sustained ROSC (RR, 1.25; 95% CI, 0.28–5.66), survival to discharge (RR, 1.08; 95% CI, 0.57–2.03), and survival to discharge with favorable neurological outcomes (RR, 2.08; 95% CI, 0.83–5.24).
Conclusions
Esmolol was associated with improved temporary ROSC in rVF. The sensitivity analysis suggests potential benefits for sustained ROSC and neurological survival, but more data are needed. Further research is needed to clarify its role.
Pediatrics
High-flow nasal cannula for respiratory support in children with severe asthma attack: a systematic review and meta-analysis
Ghea Mangkuliguna, Muhammad Ifan Romli, Adrian Djatikusumo, Nicholas Adrianto
Acute Crit Care. 2026;41(1):148-159.   Published online October 24, 2025
DOI: https://doi.org/10.4266/acc.003744
  • 3,525 View
  • 159 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
Adjunctive therapies, including high-flow nasal cannula (HFNC) and bilevel positive airway pressure, have been explored to manage severe asthma attacks and avoid invasive ventilation. HFNC has gained interest as a potential alternative. This review evaluated and compared outcomes of HFNC with conventional oxygen therapy or other non-invasive ventilation (NIV) in severe asthma. Methods: A comprehensive search of PubMed/Medline, Scopus, Cochrane Library, and gray literature identified studies published between August 25, 2014, and August 25, 2024. A random-effects meta-analysis was performed, and results were presented in a forest plot. Study quality was assessed using the Cochrane Risk of Bias tool (ROB-2) and Newcastle-Ottawa Scale. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered in PROSPERO (CRD42024558656). Results: Nine studies with 14,606 subjects were included. HFNC showed a trend toward improved pulmonary scores, though not statistically significant (P>0.05). Pediatric intensive care unit (PICU) admission and need for escalation of support did not significantly differ from standard oxygen therapy or other NIV. HFNC was associated with a modest but significant increase in readmission (odds ratio, 3.14; 95% CI, 1.07–9.24; P=0.04). PICU length of stay was comparable across groups, and mortality among HFNC-treated patients remained <1%. Overall evidence quality was very low to low. Conclusions: HFNC did not demonstrate superior outcomes over conventional oxygen therapy and other NIV. Evidence remains limited and of low quality, highlighting the need for further high-quality studies.

Citations

Citations to this article as recorded by  
  • Respiratory Support in Pediatric Critical and Near-Fatal Asthma: A Narrative Review
    Long Xiang, Herng Lee Tan, Andrew Miller, Alexandre T. Rotta, Jan Hau Lee
    Pulmonary Therapy.2026;[Epub]     CrossRef
Meta-analysis
Impact of perioperative high-intensity statin treatment on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting: a meta-analysis
Yeiwon Lee, Somin Im, Yoonjin Kang, Suk Ho Sohn, Myoung-jin Jang, Ho Young Hwang
Acute Crit Care. 2024;39(4):507-516.   Published online November 25, 2024
DOI: https://doi.org/10.4266/acc.2024.00633
  • 7,622 View
  • 217 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
This meta-analysis was conducted to evaluate the impact of high-intensity statin treatment on new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG).
Methods
Four databases were searched for studies that enrolled patients who underwent CABG and investigated the impact of perioperative use of high-intensity statins on the occurrence rate of POAF. The primary outcome was the incidence of POAF. Secondary outcomes were operative mortality and perioperative myocardial infarction (PMI). Publication bias was assessed using a funnel plot and Egger’s test.
Results
Nine articles (eight randomized controlled trials and one non-randomized study: n=3,072) were selected. Rosuvastatin (20 mg) was used in four studies, while atorvastatin (40–80 mg) was used in the other five studies. Reported incidences of POAF in the included studies ranged from 11% to 48.8%. Pooled analyses showed that the incidence of POAF was significantly lower in patients treated with high-intensity statins than in patients in the control group patients (odds ratio, 0.43; 95% CI, 0.27–0.68; P<0.001). Subgroup analyses showed that the impact of high-intensity statins was significant in studies using atorvastatin but not in studies using rosuvastatin. There was no significant subgroup difference in the primary endpoint between studies using a placebo and those using low-dose statins. Secondary outcomes, including operative mortality and the incidence of PMI, were not affected by high-intensity statin treatment.
Conclusions
Perioperative use of high-intensity statins is associated with a 57% reduction in the occurrence of POAF among patients undergoing CABG.

Citations

Citations to this article as recorded by  
  • Comparative Effects of Different Statin Regimens on Postoperative Outcomes in Isolated Coronary Artery Bypass Grafting: A Propensity Score-Matched Analysis
    Osman Fehmi Beyazal, Zeki Temizturk, Cemalettin Aydin, Mehmet Okan Donbaloglu, Arjen Erdal, Selman Sadi Citak, Nihan Kayalar, Mehmed Yanartas
    Journal of Clinical Medicine.2026; 15(15): 6060.     CrossRef
  • Cardiac Surgery 2024 Reviewed
    Hristo Kirov, Tulio Caldonazo, Murat Mukharyamov, Sultonbek Toshmatov, Philine Fleckenstein, Timur Kyashif, Thierry Siemeni, Torsten Doenst
    The Thoracic and Cardiovascular Surgeon.2025; 73(05): 332.     CrossRef
  • Impact of statin treatment on postoperative atrial fibrillation in surgical aortic valve replacement
    Lytfi Krasniqi, Joachim Sejr Skovbo, Jesper Hallas, Axel Brandes, Poul Erik Mortensen, Oke Gerke, Emil Johannes Ravn, Viktor Poulsen, Ivy Susanne Modrau, Katrine M. Müllertz, Jordi Sanchez Dahl, Lars Peter Riber
    American Heart Journal.2025; 290: 82.     CrossRef
  • Koronarchirurgie – Literaturübersicht 2024
    Philine Fleckenstein, Tulio Caldonazo, Murat Mukharyamov, Sultonbek Toshmatov, Timur Kyashif, Thierry Siemeni, Torsten Doenst, Hristo Kirov
    Zeitschrift für Herz-,Thorax- und Gefäßchirurgie.2025; 39(6): 362.     CrossRef
Pulmonary
Comparison of high-flow nasal oxygen therapy and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis
Glenardi Glenardi, Febie Chriestya, Bambang J Oetoro, Ghea Mangkuliguna, Natalia Natalia
Acute Crit Care. 2022;37(1):71-83.   Published online February 22, 2022
DOI: https://doi.org/10.4266/acc.2021.01326
  • 19,855 View
  • 564 Download
  • 12 Web of Science
  • 11 Crossref
AbstractAbstract PDFSupplementary Material
Background
Acute respiratory failure (ARF) is a major adverse event commonly encountered in severe coronavirus disease 2019 (COVID-19). Although noninvasive mechanical ventilation (NIV) has long been used in the management of ARF, it has several adverse events which may cause patient discomfort and lead to treatment complication. Recently, high-flow nasal cannula (HFNC) has the potential to be an alternative for NIV in adults with ARF, including COVID-19 patients. The objective was to investigate the efficacy of HFNC compared to NIV in COVID-19 patients.
Methods
This meta-analysis was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Literature search was carried out in electronic databases for relevant articles published prior to June 2021. The protocol used in this study has been registered in International Prospective Register of Systematic Reviews (CRD42020225186).
Results
Although the success rate of NIV is higher compared to HFNC (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.16–0.97; P=0.04), this study showed that the mortality in the NIV group is also significantly higher compared to HFNC group (OR, 0.49; 95% CI, 0.39–0.63; P<0.001). Moreover, this study also demonstrated that there was no significant difference in intubation rates between the two groups (OR, 1.35; 95% CI, 0.86–2.11; P=0.19).
Conclusions
Patients treated with HFNC showed better outcomes compared to NIV for ARF due to COVID-19. Therefore, HFNC should be considered prior to NIV in COVID-19–associated ARF. However, further studies with larger sample sizes are still needed to better elucidate the benefit of HFNC in COVID-19 patients.

Citations

Citations to this article as recorded by  
  • Comparison of high-flow nasal cannula and noninvasive ventilation in COVID-19-related hypoxemic respiratory failure: a retrospective observational study
    Ahmed Saied Abdelmohsen, Mahmoud Mohamed Emam, Khaled M. Taema, Hossam Hosni Masoud, Soliman Belal
    The Egyptian Journal of Critical Care Medicine.2026;[Epub]     CrossRef
  • Trends and management of acute respiratory failure in hospitalized patients: a multicenter retrospective study in South Korea
    Won Jin Yang, Yong Jun Choi, Kyung Soo Chung, Ji Soo Choi, Bo Mi Jung, Jae Hwa Cho
    Acute and Critical Care.2025; 40(2): 171.     CrossRef
  • 2023 Year in Review: High-Flow Nasal Cannula for COVID-19
    Michael D Davis
    Respiratory Care.2024; 69(12): 1587.     CrossRef
  • High-flow nasal cannula therapy in patients with COVID-19 in intensive care units in a country with limited resources: a single-center experience
    Anh-Minh Vu Phan, Hai-Yen Thi Hoang, Thanh-Son Truong Do, Trung Quoc Hoang, Thuan Van Phan, Nguyet-Anh Phuong Huynh, Khoi Minh Le
    Journal of International Medical Research.2023;[Epub]     CrossRef
  • Evaluating the use of the respiratory-rate oxygenation index as a predictor of high-flow nasal cannula oxygen failure in COVID-19
    Scott Weerasuriya, Savvas Vlachos, Ahmed Bobo, Namitha Birur Jayaprabhu, Lauren Matthews, Adam R Blackstock, Victoria Metaxa
    Acute and Critical Care.2023; 38(1): 31.     CrossRef
  • Does the variant positivity and negativity affect the clinical course in COVID-19?: A cohort study
    Erkan Yildirim, Levent Kilickan, Suleyman Hilmi Aksoy, Ramazan Gozukucuk, Hasan Huseyin Kilic, Yakup Tomak, Orhan Dalkilic, Ibrahim Halil Tanboga, Fevzi Duhan Berkan Kilickan
    Medicine.2023; 102(9): e33132.     CrossRef
  • The COVID-19 Driving Force: How It Shaped the Evidence of Non-Invasive Respiratory Support
    Yorschua Jalil, Martina Ferioli, Martin Dres
    Journal of Clinical Medicine.2023; 12(10): 3486.     CrossRef
  • Descriptive account of the first use of the LeVe CPAP System, a new frugal CPAP System, in adult patients with COVID-19 Pneumonitis in Uganda
    Anna Littlejohns, Helen Please, Racheal Musasizi, Stuart Murdoch, Gorret Nampiina, Ian Waters, William Davis Birch, Gregory de Boer, Nikil Kapur, Tumwesigye Ambrozi, Ninsiima Carol, Nakigudde Noel, Jiten Parmar, Peter Culmer, Tom Lawton, Edith Namulema
    Tropical Medicine and Health.2023;[Epub]     CrossRef
  • Mechanical ventilation and outcomes in COVID-19 patients admitted to intensive care unit in a low-resources setting: A retrospective study
    Sarakawabalo Assenouwe, Tabana Essohanam Mouzou, Ernest Ahounou, Lidaw Déassoua Bawe, Awèréou Kotosso, Koffi Atsu Aziagbe, Eyram Makafui Yoan Amekoudi, Mamoudou Omourou, Chimene Etonga Anoudem, Komi Séraphin Adjoh
    Journal of Acute Disease.2023; 12(5): 186.     CrossRef
  • Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis
    Yun Peng, Bing Dai, Hong-wen Zhao, Wei Wang, Jian Kang, Hai-jia Hou, Wei Tan
    Therapeutic Advances in Respiratory Disease.2022;[Epub]     CrossRef
  • Does High Flow Nasal Cannula avoid intubation and improve the mortality of adult patients in acute respiratory failure in the intensive care setting, when compared to others methods as Conventional Oxygen Therapy or Non-Invasive Ventilation? A narrative r
    P Fosseur, A Renard, P Mateu, J Rosman
    Acta Anaesthesiologica Belgica.2022; 73(Supplement): 97.     CrossRef
ACC : Acute and Critical Care
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