Life-threatening flecainide overdose treated with intralipid and extracorporeal membrane oxygenation

Brumfield, Emily; Bernard, Kenneth; Kabrhel, Christopher

doi:10.1016/j.ajem.2015.04.012

Cited by 30 publications

(22 citation statements)

References 13 publications

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“…Sodium bicarbonate (NaHCO₃) is commonly used to reverse drug‐induced sodium channel blockade caused by different agents including flecainide . While there are no definitive guidelines for management of severe flecainide intoxication, intravenous fat emulsion (IFE) and extracorporeal membrane oxygenation (ECMO) have been successfully used …”

Section: Discussionmentioning

confidence: 99%

Wolff‐Parkinson‐White, Brugada phenocopy, and flecainide toxicity: All in one patient

Alhaj

Banning

Vasaiwala

et al. 2019

Clinical Case Reports

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Key Clinical Message Accessory pathway Wolff‐Parkinson‐white is sometimes not manifested till later in life, as the conduction properties of AV node become slower, other mechanisms are also possible. Brugada pattern on EKG can be associated with various underlying clinical conditions, such as mechanical compression of RVOT by tumors. It is essential to have high index of suspicion for flecainide toxicity when encountering arrhythmias in patients taking the drug.

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Section: Discussionmentioning

confidence: 99%

Wolff‐Parkinson‐White, Brugada phenocopy, and flecainide toxicity: All in one patient

Alhaj

Banning

Vasaiwala

et al. 2019

Clinical Case Reports

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“…The exact action of IFE is unclear, but the lipophilic properties of IFE seem to neutralize the flecainide's toxicity [10]. Some cases have been described with different approaches resulting in good outcomes, but these need more investigation to validate their efficacy in this setting [11][12][13][14][15]. In addition, due to its micellar action, blood dose tracking is distorted and the American College of Medical Toxicology recommends IFE when there is hemodynamic instability, but not in cardiac arrest patients [16].…”

Section: Discussionmentioning

confidence: 99%

“…VA-ECMO was stopped after 5 days with a good neurologic outcome [4]. Also in 2015, in a case described by Brumfield et al, VA-ECMO was started after three rounds of advanced life support (ALS) and was stopped with a good neurologic outcome [13]. Our first case shows, despite the age of our 71-year-old patient and prolonged CPR, VA-ECMO proved beneficial, with a favorable cardiologic outcome and a preserved neurologic state.…”

Section: Discussionmentioning

confidence: 99%

Three Cases of Cardiac Arrest with Massive Flecainide Intoxication Treated with Extracorporeal Assistance

Domont

Bouckaert

2019

Méd. Intensive Réa.

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Trois cas d'arrêt cardiaque sur intoxication sévère à la flécaïnide traités avec assistance circulatoire extracorporelle P. Domont (MD (Titulaire d'un doctorat en médecine)) · Y. Bouckaert (MD (Titulaire d'un doctorat en médecine)) Abstract Flecainide acetate is a Vaughan Williams class 1C anti-arrhythmic agent. Overdose causes severe cardiac and neurologic disturbances and carries a risk of fatality. No antidote is currently available. We present three cases of massive flecainide intoxication in which the patients were kept alive by extracorporeal circulation. Extracorporeal support in cases of flecainide intoxication is the only approach that can alleviate acute cardiac dysfunction, preserve blood flow to vital organs, and maintain liver metabolism and renal excretion of the toxin, while waiting for the improvement of cardiac function. Furthermore, clinical practice highlights that age, duration of CPR, PH, and lactate levels should not be a hindrance to decision-making, and demonstrates the positive, long-term neurologic and cardiologic outcomes that can be achieved with the use of extracorporeal assistance in the setting of severe flecainide intoxication. Keywords Flecainide · Venoarterial extracorporeal membrane oxygenation · VA-ECMO · Cardiac arrestRésumé La flécaïnide est un antiarythmique de classe 1C selon la classification de Vaughan-Williams. Son surdosage entraîne de graves troubles cardiaques et neurologiques, avec un risque létal. À ce jour, aucun antidote n'est disponible. Nous vous présentons trois cas d'intoxication au flécaïnide maintenus en vie par circulation extracorporelle. Les trois cas ont présenté une durée de support différente. À l'heure actuelle, le support via circulation extracorporelle dans le cadre d'un arrêt cardiaque sur intoxication au flécaïnide est le seul qui permet de suppléer la dysfonction cardiaque aiguë, d'assurer un maintien de la perfusion des organes vitaux, de la métabolisation hépatique et l'excrétion rénale du toxique, en attendant la récupération de la fonction cardiaque. Cette pratique clinique met en évidence une série de facteurs (âge du patient, durée de réanimation, pH et lactatémie en ce compris durant la RCP) qui ne doivent pas être un frein à la prise de décision et souligne un excellent devenir neurologique et cardiaque à long terme.

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“…The therapeutic end point for treatment is narrowing of the QRS on ECG. If multiple doses fail to narrow the QRS complex and improve the hemodynamics, then alternative treatment options, lipid emulsion therapy, and extracorporeal membrane oxygenation (ECMO) can be considered [6,11,12,[15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

A case of neonatal single twin flecainide toxicity after therapeutic in utero exposure for fetal SVT

Barot

Seslar

Dolgner

et al. 2017

Toxicology Communications

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A case of neonatal single twin flecainide toxicity after therapeutic in utero exposure for fetal SVT, Toxicology Communications, 1:1, 41-44, ABSTRACTA 9 hour old twin neonate, who was treated with flecainide in utero for fetal supraventricular tachycardia, presented with hypotension and a wide complex tachycardia concerning for flecainide toxicity. The patient was given a bolus of sodium bicarbonate with transient narrowing of her QRS complex. She was then intubated and started on a sodium bicarbonate drip with full resolution of her wide complex tachycardia within 24 hours. Work up showed no evidence for structural cardiac pathology or infection and she did not experience any further arrhythmias after termination of her presenting wide complex tachycardia. The patient was discharged home at 10 days of age and has had no further sequelae. This case report describes a novel presentation of in utero flecainide toxicity and summarizes the therapies available to treat this rare, but potentially lethal, presentation.

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Life-threatening flecainide overdose treated with intralipid and extracorporeal membrane oxygenation

Cited by 30 publications

References 13 publications

Wolff‐Parkinson‐White, Brugada phenocopy, and flecainide toxicity: All in one patient

Wolff‐Parkinson‐White, Brugada phenocopy, and flecainide toxicity: All in one patient

Three Cases of Cardiac Arrest with Massive Flecainide Intoxication Treated with Extracorporeal Assistance

A case of neonatal single twin flecainide toxicity after therapeutic in utero exposure for fetal SVT

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