Pharmacy & Acute Care University
Pharmacy & Acute Care University

PACULit

PACULit

Stay ahead in your specialty without falling behind in your schedule. Daily literature updates, audio summaries, and CE credits tailored for healthcare professionals.

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Who This Is For

Emergency Medicine & Critical Care

Emergency Medicine Pharmacists Critical Care Pharmacists Emergency Physicians Intensivists ICU Nurses & NPs Trauma Surgeons PGY2 EM/CC Residents

Pediatrics

Pediatric Pharmacists Pediatricians Pediatric Intensivists Neonatologists Pediatric Nurses Pediatric NPs PGY2 Pediatric Residents

Oncology

Oncology Pharmacists Hematologists/Oncologists Oncology Nurses Oncology NPs Clinical Trial Coordinators BMT Teams PGY2 Oncology Residents

Internal Medicine/ID/Cardiology

Clinical Pharmacists Hospitalists Cardiologists ID Physicians Internal Medicine Residents Stewardship Teams Clinical Nurse Specialists

Specialty Pharmacy

Specialty Pharmacists Clinical Specialty Coordinators Outcomes Research Specialists Patient Care Coordinators Payer Relations Specialists Health-System Specialty Teams

Why PACULit?

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5-Minute Updates

Get the evidence you need without the research burden. Expert-curated studies delivered daily in digestible formats.

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Specialty Focused

Choose tracks tailored to your practice: Emergency/Critical Care, Pediatrics, Oncology, Internal Medicine, and Specialty Pharmacy.

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Audio Learning

Transform your commute into learning time with 5-minute audio overviews of key studies and clinical implications.

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CE Credits Included

Earn 3-5 hours of continuing education credits monthly while staying current with the latest evidence.

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Emergency Medicine & Critical Care

Sepsis management, resuscitation protocols, shock states, and critical care therapeutics

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Pediatrics

Age-specific dosing, pediatric RCTs, safety data, and developmental considerations

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Oncology

Novel agents, immunotherapy, CAR-T developments, and supportive care protocols

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Internal Medicine/ID/Cardiology

Heart failure, antimicrobial stewardship, diabetes care, and general medical conditions

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Specialty Pharmacy

High-cost biologics, rare diseases, complex therapeutics, and clinical outcomes

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Experience PACULit

📚 LearnDash Course Experience

Interactive learning with CE credits - Sample from our Emergency Medicine track

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PACULit Daily Literature Update

🎓 CE Credit Available: 0.25 Hours

Landiolol for refractory ventricular fibrillation in out-of-hospital cardiac arrest: A randomized double-blind placebo-controlled pilot trial

Gelbenegger G, Jilma B, Horvath LC, et al. Resuscitation. 2024 Aug;201:110273-. PMID: 38866231.

📖 Introduction

Refractory ventricular fibrillation in out-of-hospital cardiac arrest represents one of the most challenging scenarios in emergency medicine, with historically poor outcomes despite advances in resuscitation protocols. This landmark trial assessed whether landiolol, a short-acting beta-blocker, could improve clinical outcomes when added to standard advanced life support measures.

📊 Study Design & Methodology

Study Type: Randomized double-blind placebo-controlled pilot trial

Population: 36 patients with refractory VF after OHCA

Intervention: 20 mg bolus infusion of landiolol vs placebo

Primary Outcome: Time to sustained ROSC

Safety Endpoints: Incidence of bradycardia and asystole during resuscitation

🔍 Key Findings

  • Primary Outcome: No difference in median time to sustained ROSC: 39 min (landiolol) vs 41 min (placebo) - p = 0.84
  • Efficacy Concern: Sustained ROSC rate actually lower with landiolol (36.8%) compared to placebo (64.7%)
  • Safety Signal: Asystole occurred significantly more frequently in landiolol group (36.8%) vs none in placebo group
  • Clinical Implication: Landiolol may actually worsen outcomes in this critical population

🔬 Comprehensive Evidence Synthesis & Clinical Context

The findings of Gelbenegger et al. provide crucial high-quality evidence that challenges previous observational data and reinforces current guideline recommendations against beta-blocker use in acute refractory VF scenarios.

🏛️ Guideline Landscape

  • Panchal et al., 2020 (AHA Guidelines): American Heart Association guidelines explicitly do not recommend beta-blockers for refractory VF resuscitation, establishing clear standard of care protocols
  • Soar et al., 2021 (ERC Guidelines): European Resuscitation Council guidelines similarly advise against beta-blocker use during acute advanced life support (PMID: 33773835)
  • Clinical Consensus: International agreement on avoiding beta-blockade in acute resuscitation phases

📊 Conflicting Observational Evidence

  • Miraglia et al., 2020 (Systematic Review): Found observational studies suggested esmolol was associated with improved ROSC and survival, but concluded evidence was of 'very low' quality and inconclusive (PMID: 32777667)
  • Stupca et al., 2023: Retrospective analysis suggested esmolol may improve ROSC rates, but limited by historical controls and selection bias (PMID: 36436299)
  • Driver et al., 2014: Single-center retrospective study hinted at potential benefit but acknowledged significant methodological limitations (PMID: 25033747)
  • Driver et al., 2022: Demonstrated prehospital esmolol administration is feasible but provided no efficacy data (PMID: 35387498)

🎯 Meta-Analysis Context

  • McLeod et al., 2017: Large network meta-analysis found no antiarrhythmic agent, including beta-blockers, significantly improves survival to hospital discharge in OHCA, providing broader context for negative findings (PMID: 29037886)
  • Evidence Hierarchy: The Gelbenegger study represents the highest quality evidence to date - a prospective, randomized, placebo-controlled trial
🧩 Evidence Integration

This rigorous, prospective data provides the strongest evidence to date and definitively cautions against routine use of beta-blockade during active resuscitation for refractory VF, resolving the uncertainty created by lower-quality observational studies.

⚕️ Clinical Implications & Practice Recommendations

  • Immediate Practice: Do not use beta-blockers such as landiolol for refractory VF during active resuscitation based on current high-quality evidence
  • Standard Care: Follow established guideline recommendations emphasizing epinephrine and amiodarone as evidence-based interventions
  • Safety Monitoring: Be vigilant for adverse events if beta-blockers are considered experimentally or off-label in specialized contexts
  • Quality Improvement: Use this evidence to update institutional protocols and training programs

🧠 Knowledge Check Preview

Sample question from the full course assessment:

"Based on the Gelbenegger et al. trial, what is the most appropriate clinical action regarding landiolol use in refractory VF?"

Complete the full course to access interactive assessments and earn CE credits

✅ Clinical Bottom Line

Landiolol does not improve return of spontaneous circulation in refractory VF after OHCA and may increase asystole risk, providing definitive evidence supporting guideline recommendations against beta-blocker use in acute resuscitation settings.

© 2025 PACULit | ACPE Accredited Provider

🎧 5-Minute AI Audio Overview

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What Healthcare Professionals Say

"PACULit delivers exactly what I need - clinically relevant updates without the time burden. The summaries are perfectly tailored to what actually impacts my practice."

- Ryan Watts, PharmD, BCPS

"The specialty pharmacy track is a game-changer. Finally, literature updates that understand the complexity of high-cost, high-touch therapies. It's incredibly convenient to get this level of curation."

- Keia Pruitt, PharmD

"As an oncologist, staying current is critical but time-consuming. PACULit's oncology track delivers the most relevant studies with clear clinical implications - exactly what I need between patient visits."

- Jerel David, MD

"Pediatric-specific evidence is often buried in general literature. PACULit's pediatrics track saves me hours by curating what actually matters for my young patients. The convenience factor is huge."

- Kevin Allen Jr, MD

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