ECMO for pulmonary rescue in an adult with amiodarone-induced toxicity

Abstract

Amiodarone is a highly effective antiarrhythmic agent. Unfortunately amiodarone-induced pulmonary toxicity is described for medium-long term therapy. We describe a case of a 65-year-old man admitted to our department for breathlessness and with a history of recurrent episodes of atrial fibrillation for which he had been receiving amiodarone (200 mg/day) since 2008. Despite diuretic therapy, along with aspirin, statins and antibiotics the patient continued to complain of severe dyspnea and had a moderate fever. Thus, diagnostic hypotheses different from acute cardiac failure were considered, in particular non-cardiogenic causes of pulmonary infiltrates. Following suspicion of amiodarone-induced pulmonary toxicity, the drug was discontinued and corticosteroid therapy was initiated. Due to the deterioration of the clinical picture, we proceeded to intubation. After few hours from intubation we were forced to institute a veno-venous extracorporeal membrane oxygenation due to the worsening of pulmonary function. The patient's clinical condition improved which allowed us to remove the ECMO after 15 days of treatment. Indications for use of ECMO have expanded considerably. To our knowledge this is the first successful, reported article of a veno-venous ECMO used to treat amiodarone-induced toxicity in an adult. In patients with severe but potentially reversible pulmonary toxicity caused by amiodarone, extracorporeal life support can maintain pulmonary function and vital organ perfusion at the expense of low morbidity, while allowing time for drug clearance.

Amiodarone Induced Pulmonary Toxicity: A Fatal Case Report

“…The incidence of AIPT is 2% to 10% and mortality rate ranges from 10% to 50% in patients who develop acute respiratory distress syndrome (ARDS) [3]. Although AIPT has no pathognomonic clinical, laboratory, radiographic or histological findings the diagnosis depends on clinical suspicion and exclusion of other possibilities of pulmonary disease [3,4]. Risk factors for AIPT include age, duration and intensity of therapy (cumulative dose), preexisting lung disease, thoracic surgery and pulmonary angiography [3,5].…”

Risk factors for amiodarone‐induced thyroid dysfunction in Japan

“…However, amiodarone is associated with a number of significant adverse effects [1,2], including elevated transaminase levels, pulmonary fibrosis, arrhythmia, and thyroid dysfunction. Although thyroid dysfunction is considered to be a common and potentially serious adverse effect of amiodarone therapy [1,3], the exact pathogenesis remains unknown because of its complex manifestations [4]. The effects of amiodarone on the thyroid have been attributed to its iodine content and intrinsic properties [5].…”