Beta-adrenergic antagonists improve oxygen saturation in acute pulmonary edema: a case series in the prehospital setting.

The use of beta-adrenergic antagonists in acute heart failure is controversial. In this case series, we report the use of intravenous atenolol, a short-acting cardioselective beta-adrenergic antagonist, to treat acute pulmonary edema in the prehospital setting. Four patients with a documented history of cardiac disease and one patient with unknown cardiac issues experienced severe respiratory distress and presented with pulmonary edema; the local emergency medical service was utilized. In all of the patients, the saturation of peripheral oxygen (SpO2) was severely low, and the patients were rapidly treated with oxygen, diuretics, morphine, and nitrates. However, only a small increase in oxygen saturation was observed. Intravenous atenolol was administered and led to a dramatic increase in SpO2. In our case series, we observed the positive effect of early treatment with short-acting beta-adrenergic antagonists on the recovery of rapid oxygen delivery in severely hypoxemic patients.