Esmolol facilitated extubation in a patient with severe systolic dysfunction following myocardial infarction

We describe the case of a 59-year-old-man with acute myocardial infarction and severely impaired left ventricular systolic function who was intubated because of recurrent ventricular fibrillation in the setting of coronary angioplasty. Repeated ventilator weaning attempts and extubation initially failed, as severe tachycardia and hypertension occurred each time the patient began to awaken. Pre-treatment with esmolol infusion prevented the above haemodynamic changes, allowing successful extubation. Esmolol administration at ventilator weaning seems to be a safe and effective option, even in selected patients with impaired left ventricular contractility.