Safety and Hemodynamic Effects of Intravenous Labetalol for Acute Aortic Dissection in the Emergency Department

Acute aortic dissection (AAD) requires rapid reduction of aortic wall stress by strict control of heart rate (HR) and systolic blood pressure (SBP). While intravenous (IV) beta-blockers are commonly recommended, guidance on optimal agents remains limited, with selection largely informed by pharmacologic properties and anticipated hemodynamic effects. This study is the first to describe IV labetalol use for AAD in the emergency department (ED).

We conducted a single-center, retrospective descriptive cohort study of adults with computed tomography-confirmed AAD who received IV labetalol from January 2020 to August 2025. Exclusion criteria included other IV antihypertensive therapy within 30 minutes, non-acute aortic pathology, IV esmolol administration, pregnancy, or incarceration. Primary outcomes, measured within three hours, were hypotension (SBP less than 90 mmHg), bradycardia (HR less than 50 bpm), and vasopressor use. Secondary outcomes included achieving hemodynamic targets and using additional antihypertensive therapy. Outcomes were stratified by IV push (IVP), infusion, or both, and interrater reliability was assessed using Cohen’s Kappa and Spearman’s Rho.

Of 114 patients, 27 met the inclusion criteria; most exclusions were due to non-acute dissection or prior IV antihypertensive use. Interrater reliability was moderate to perfect. Fifteen patients (56%) had type A dissections, and 12 (44%) type B. Sixteen patients (59%) were male, with a mean age of 57 years. Five patients received IVP only, 10 received infusion only, and 12 received both. Hypotension occurred in 40% with IVP, 30% with infusion, and 16.7% with both; bradycardia occurred in 20% with IVP. Vasopressor use occurred in 60% with IVP, 10% with infusion, and 8.3% with both. Additional antihypertensive therapy was required in 40% with IVP, 20% with infusion, and 50% with both. Hemodynamic targets were generally achieved, with IV infusion or combined therapy showing higher success than IVP alone; adverse hemodynamic events were transient and managed with infusion adjustments, brief interruptions, or vasoactive therapy.

Intravenous labetalol demonstrated acceptable early hemodynamic control with low rates of serious adverse events in patients with AAD treated in the ED. These results offer preliminary safety and utilization data and support the need for larger, multicenter studies.