Читать книгу Emergency Medical Services - Группа авторов - Страница 233

Older guidelines recommended IV beta‐blocker (typically metoprolol) administration early in the course of acute myocardial infarction because of data suggesting reduced rates of reinfarction and recurrent ischemia when patients received both fibrinolytics and IV beta‐blockers. A large placebo‐controlled randomized trial showed that the effect of beta‐blockers in reducing arrhythmic events is equally offset by an increase in development of cardiogenic shock, and survival is similar regardless of early administration of intravenous beta‐blockers [43]. Current AHA/ACC recommendations for administration of intravenous beta‐blockers in the setting of STEMI are limited to patients who are hypertensive or have ongoing ischemia with no contraindications to their use [16]. On balance, the guidelines suggest that the need for prehospital administration of beta‐blockers to patients with STEMI is limited.