Approach to BRASH Syndrome in the emergency department: Systematic scoping review
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Abstract
BRASH syndrome is a severe condition combining bradycardia, renal insufficiency, AV block, shock, and hyperkalemia, leading to a potentially fatal feedback loop if not promptly treated. Accurate diagnosis and appropriate treatment are essential, differing from similar conditions, necessitating a specific approach to prevent severe complications. This review aims to synthesize and critically analyze published studies on the syndrome, focusing on its management in the emergency department. A systematic scoping review was conducted following the PRISMA-ScR guideline, covering Scholar Google, LILACS, and PubMed from 2018 to 2024. Thirty-five studies were included, totaling a sample of 40 patients with an average age of 76 years, predominantly female (65.0%). Betablockers (80.0%), particularly carvedilol (42.5%), and calcium channel blockers (60.0%), notably amlodipine (30.0%), were the primary medications implicated in the syndrome. The most common electrocardiographic abnormality observed was junctional bradycardia (50%), with most patients benefiting from supportive therapy focusing on hyperkalemia and hemodynamic shock control. Further robust studies are needed to better identify risk factors, effective treatments, and safety considerations for resuming AV-blocking medications in this population.
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