Extracorporeal Life Support in Severe Propranolol and Verapamil Intoxication

Kołcz, Jacek; Pietrzyk, Jacek A; Januszewska, Katarzyna; Procelewska, Malgorzata; Mroczek, Tomasz; Malec, Edward

doi:10.1177/0885066607307528

Cited by 66 publications

(43 citation statements)

References 22 publications

(30 reference statements)

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“…When taken in overdose, β-blocker intoxication presents a formidable therapeutic challenge. Current recommendations for the treatment of β-blocker poisoning advocate infusion of catecholamines [12], calcium chloride [13], glucagon [14,15] and extracorporeal life support [16] in instances of refractory cardiovascular collapse. More recently, high-dose insulin-glucose euglycaemia [17,18] and Levosimendan [19] have been demonstrated effective in animal models and clinical cases of β-blocker toxicity.…”

Section: Introductionmentioning

confidence: 99%

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

2010

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Intravenous lipid emulsion (ILE) has been demonstrated to be an effective treatment for systemic toxicity associated with local anaesthetics and increasingly non-local anaesthetic agents of high lipophilicity. Effect for ILE has been demonstrated in animal models of propranolol poisoning; however, any benefit for ILE in more hydrophilic β-blockers remains uncertain. We determined to examine the effect of ILE on haemodynamic recovery following induction of hypotension with the relatively hydrophilic β-blocker, metoprolol. Twenty sedated, invasively monitored and mechanically ventilated adult New Zealand white rabbits underwent metoprolol infusion to mean arterial pressure (MAP) 60% baseline. Intravenous rescue was given according to the following groups: 6 mL/kg 20% lipid emulsion or 6 mL/kg 0.9% saline solution over 4 min. Haemodynamic parameters were obtained in 15 min. MAP was 70 (interquartile range (IQR), 58-82) mmHg saline group and 79 (IQR,(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89) mmHg ILE group at baseline, and 38 (IQR, 33-40) mmHg saline group and 41 (IQR, 40-43) mmHg ILE group, respectively, following metoprolol infusion. No statistically significant difference between ILE and saline-treated groups was observed in MAP, or pulse rate, at any time point following rescue therapy. ILE was not effective in reversal of metoprolol-induced hypotension in this rabbit model. These findings lend inferential support for the 'lipid sink' as principal mechanism for the beneficial effect observed with ILE administration in other models of lipophilic β-blocker-induced toxicity.

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Section: Introductionmentioning

confidence: 99%

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

2010

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“…11 of the patients (68,8%) were female and 5 (31,2%) were male. The mean age of the patients was 11,8±5,94 (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) years. 11 of the patients (68,8%) ingested the drug with the aim of suicide.…”

Section: Resultsmentioning

confidence: 99%

“…Combined use of calcium and adrenalin is recommend, if there are cardiotoxicity findings (12). Jacek et al (17) argued that life-supportive therapies including plasmapheresis were beneficial in fatal cardiotoxic drug intoxications. Gastric lavage and active charcoal administration were performed in six of the 7 patients with CCB intoxication who presented to the emergency department in the first 2 hours.…”

Section: Discussionmentioning

confidence: 99%

Kalsiyum kanal blokeri veya beta bloker ilaçlarla zehirlenen çocukların değerlendirilmesi

Konca¹,

Yildizdaş²,

Sarı³

et al. 2013

Tpa

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SummaryAim: Calcium channel blockers (CCB) and beta blockers (BB) are primarily used to treat hypertension. Overdose of these medications can occur by accidental ingestion or ingestion for suicide attempt. Morbidity and mortality are higher in these poisonings compared to other poisonings. In this study, BB or CCB drug poisoning cases are discussed and the literature is reviewed. Material and Method: Between January 2011 and July 2012, 590 cases of drug poisoning were admitted in the Pediatric Intensive Care Unit. In this study, 16 of these 590 subjects who were poisoned with calcium channel blockers or beta blockers were evaluated. 11 (68.8%) patients were female and 5 (31.2%) were male. Mean age of the patients was 11.8±5.94 (2.5-18) years. Results: Hypotension was the most common clinical sign in CCB poisoning. Two patients were asymptomatic. On ECG, QT prolongation was found in four patients, AV block was found in two patients and ST depression was found in one patient. Nausea, vomiting, hypotension, lethargy and tremor were the most common clinical findings in patients with BB intoxication. Although seven patients had normal ECG, one patient had QT prolongation and one patient had Wolff-Parkinson-White syndrome. Only dopamine was given to two patients with CCB poisoning, dopamine and dobutamine were given to one patient and dopamine, dobutamine, epinephrine, norepinephrine, glucagon and insulin were given to another patient. Inotropic drugs were not given to any patient with BB poisoning. IV Ca-gluconate was given to all patients with CCB poisoning except two patients who were asymptomatic. 15 patients were discharged, while one patient with CCB poisoning was lost. Conclusions: Because the prognosis of CCB or BB poisoning may be very severe, these patients should be followed up in a fullyequipped pediatric intensive care unit. (Turk Arch Ped 2013; 48: 138-144)

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“…Veno-venous ECMO requires less heparin than veno-arterial ECMO, thus reducing mortality from bleeding. ECMO was reported in several cases of CCBs poisoning [8][9][10], in all of them veno-arterial ECMO was used because of cardiovascular collapse. This is unlike our case where veno-venous ECMO was used due to ARDS.…”

Section: Discussionmentioning

confidence: 99%

“…Few case reports described the successful use of extracorporeal membrane oxygenation (ECMO) for CCBs poisoning [8][9][10]. Only one case report of ECMO used for ILE-induced ARDS was published [11], the procedure was veno-arterial ECMO, not veno-venous.…”

Section: Introductionmentioning

confidence: 99%

Acute Respiratory Distress Syndrome Associated with Intravenous Lipid Emulsion Therapy for Verapamil Toxicity, Successfully Treated with Veno-Venous ECMO

Friedman¹,

Feld²,

Adler³

et al. 2017

J Dev Drugs

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Calcium channel blocker (CCB) overdose is a potentially fatal poisoning. The use of intravenous lipid emulsion (ILE) therapy for CCB poisoning has emerged in the past few years. In 2017, the American College of Medical Toxicology published interim guidance for the use of ILE resuscitation in these cases. We report an uncommon complication of ILE, acute respiratory distress syndrome, treated with veno-venous extracorporeal membrane oxygenation (ECMO).Case report: A 40-year-old hypertensive woman presented with shock (blood pressure 62/34 mmHg, pulse 86/ min) following ingestion of 4,800 mg verapamil slow release and 1,500 mcg clonidine during a suicide attempt. She was treated with calcium gluconate, sodium bicarbonate, IV high dose insulin, IV glucagon, cardiac amines and vasopressors without response (blood pressure 69/37 mmHg, pulse 78/min). ILE was initiated, and two hours later, she developed acute respiratory failure necessitating intubation and mechanical ventilation. Due to poor oxygenation (pO 2 44 mmHg; FiO 2 100%) emergent veno-venous ECMO was instituted. After one hour her blood pressure increased to 104/50 mmHg (pulse 80, pO 2 75 mmHg), and continued so until weaning from ECMO and ventilation. Conclusion:Acute respiratory distress syndrome can be a major life threating complication following ILE; venovenous ECMO is suggested for its treatment.

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Extracorporeal Life Support in Severe Propranolol and Verapamil Intoxication

Cited by 66 publications

References 22 publications

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

Intravenous Lipid Emulsion Does Not Augment Blood Pressure Recovery in A Rabbit Model of Metoprolol Toxicity

Kalsiyum kanal blokeri veya beta bloker ilaçlarla zehirlenen çocukların değerlendirilmesi

Acute Respiratory Distress Syndrome Associated with Intravenous Lipid Emulsion Therapy for Verapamil Toxicity, Successfully Treated with Veno-Venous ECMO

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