“Chaotic Arrhythmia” During Successful Resuscitation After Ingestion of Yew (Taxus baccata) Needles

Abstract

Objective The study aims to describe the management of a case of life-threatening yew (Taxus baccata) intoxication. Background The needles of the yew tree contain highly cardiotoxic taxines. Intoxication with taxines, typically as part of suicide attempts, may lead to potentially lethal arrhythmias which often require prolonged cardiopulmonary resuscitation and other supportive measures. No specific therapy has been described. In some cases, extracorporeal life support has been used. Case After an attempted suicide with yew needles and out-of-hospital cardiac arrest, a female adolescent was resuscitated for 6 hours according to Advanced Cardiovascular Life Support guidelines. Complex ventricular tachycardias were treated by repeated direct current shocks and broad complex bradycardia managed with transvenous cardiac pacing. Antiarrhythmic drugs (amiodarone, lidocaine), magnesium sulfate, and supportive measures (intravenous lipids, sodium bicarbonate) were provided. The arrhythmias finally resolved, and the patient did not show any significant neurological or cardiac short-term sequelae after 24 hours. Results The authors describe the successful management of a case of severe taxine intoxication by prolonged conventional advanced cardiac life support lasting for more than 6 hours. Conclusions In life-threatening yew intoxication, prolonged cardiopulmonary resuscitation is absolutely essential owing to the long duration of the cardiotoxic action of taxines and can lead to an outcome without cardiac or neurological sequelae.

Fatal ingestion ofTaxus baccata: English yew

“…Other reported potential clinical signs and symptoms include somnolence and coma, hypotension [15,20,24], mydriasis [14,16], and anisocoria [7]. Refractory polymorphic ventricular tachycardia often with prolonged QRS intervals, degenerating to ventricular fibrillation has been directly observed in poisoned patients [7,15,16,18,19,[21][22][23][24][25][28][29][30][31].…”

“…Lethal consumption of T . baccata is recognized within academic literature to be associated with toxic ingestions, both accidental and intentional [5,7,9,11,14–27]. The possibility for homicidal intent exists as a genuine risk [5,11,24].…”

“…Considering the history, circumstances, and autopsy findings as a whole, death was attributed to toxic ingestion of Taxus baccata -the English yew. Lethal consumption of T. baccata is recognized within academic literature to be associated with toxic ingestions, both accidental and intentional [5,7,9,11,[14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The possibility for homicidal intent exists as a genuine risk [5,11,24].…”

“…Intoxication with this plant may present variably with nonspecific symptoms such as nausea, vomiting, dizziness, seizures, and abdominal pain, and can be followed by cardiac palpitations with tachycardia and or bradycardia and sudden cardiorespiratory arrest [7,14,[17][18][19][20]22,[26][27][28]. Other reported potential clinical signs and symptoms include somnolence and coma, hypotension [15,20,24], mydriasis [14,16], and anisocoria [7].…”

Clinical Toxicology of Yew Poisoning

“…A total of 26 case reports of acute yew poisoning were identified in our literature search (see Table 2). 15-40 Of the 26 cases, 9 (35%) were female and 17 (65%) male, with an average age of 30 years (range = 19 months to 55 years). Surprisingly, only 2 case reports 15,16 in our series (8%) were accidental poisonings, with the rest being deliberate ingestions.…”