• Parthav Shah, Maan Gozun, Koichi Keitoku, Nobuhiko Kimura, Jihun Yeo, Torrey Czech, and Yoshito Nishimura.
• Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, 1356 Lusitana St., Room 715, Honolulu, HI 96813, USA.
• Eur. J. Intern. Med. 2022 Sep 1; 103: 57-61.

BackgroundBradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH) syndrome is a recently-established entity precipitated by medication-induced AV nodal blockade. Despite its serious consequences, including death, clinical presentations, risk factors, and outcomes of the syndrome have not been well defined. We aim to summarize the existing evidence of BRASH syndrome.MethodsAccording to the PRISMA Extension for Scoping Reviews, we performed a search on MEDLINE and EMBASE for articles with keywords including"BRASH syndrome" and "bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia," from the inception of these databases to March 4, 2022.Results34 articles, including one observational study, 15 conference abstracts, and 18 case reports and case series, were included. While most patients were on beta blockers (83.3%) or calcium channel blockers (45.2%), other medications such as amiodarone were identified as precipitating agents. Atropine or glucagon were ineffective in reversing patients' symptoms, and 59.5% required inotropes or chronotropes. 7.1% expired due to BRASH syndrome.ConclusionsThis systematic review summarizes the clinical characteristics of BRASH syndrome. Further studies to identify risks associated with the onset of BRASH syndrome and awareness of the critical syndrome are warranted.Copyright © 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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