Near-fatal betaxolol self-poisoning treated with percutaneous extracorporeal life support

Abstract

We present a case of successful treatment of near-fatal beta-blocker self-poisoning but requiring extracorporeal circulatory support with severe complications. A 38-year-old woman ingested a mixture of tablets including betaxolol (5.32 g). Despite intensive treatment with fluid, dobutamine, isoprenaline, epinephrine, nor-epinephrine and glucagon, sustained cardiogenic shock occurred with almost complete hypokinesia of the left ventricular 14 h later. Therefore, a cardiac support was performed with a percutaneous cardiopulmonary bypass device at bedside. We review the literature with emphasis on both the best time to start this technique and its complications.

Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases

“…In previous cohort studies [19,22], survival rates were clearly higher in the toxic cardiac arrest group, as compared with other causes of cardiac arrest (3 of 12 vs 0 of 5 [19] and 4 of 6 vs 4 of 34 [22], respectively). The high survival rate (76%) reported in our cohort was in accordance with the general survival rate from 58% (15 of 26) in case reports of poisoned patients who benefited from ECLS [3-14,16,17,19]. The 5 of 7 (71%) survival rate we reported among patients with cardiac arrest was in contrast with the dramatically low survival rate of 7% and 4.5%, respectively, reported in overdoses involving cardiac arrest [29,30].…”

“…Although cardiovascular bypass is rarely used in the management of poisoning, it may have potential benefits for hemodynamic instability not responding to conventional measures. Promising results have been obtained using temporary circulatory support in several single-case reports [3-17] and short series [18,19]. However, the usefulness of cardiovascular bypass in drug-induced cardiac failure remains unclear [20].…”

Extra-corporeal life support for near-fatal multi-drug intoxication: a case report

“…With regard to CCB and BB, only a few clinical cases have been reported in the literature, both as single-drug and multi-drug intoxications [8,9], and, to our knowledge, a case series of six patients [10] who presented with massive ingestion of cardiotoxic drugs, including anti-arrhythmic agents, is up to now the largest study ever published about implementing ECMO as a bridge to standard treatment.…”

Successful Treatment of Metoprolol-Induced Cardiac Arrest With High-Dose Insulin, Lipid Emulsion, and ECMO

“…Venoarterial extracorporeal membrane oxygenation is an emerging support measure for acutely poisoned patients and demonstrates promise [8][9][10][11][12][13][14][15][16][17][18]. Providing adequate circulation restores vital organ perfusion, allowing for intrinsic drug metabolism and elimination [11].…”

“…This illustrates the need for medical interventions that reduce mortality in this population [7]. In massive overdose, traditional therapies such as glucagon, atropine, and vasopressors are insufficient; and circulatory device support, as well as high-dose insulin and intralipid therapies, may be indicated [8][9][10][11][12][13][14][15][16]. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) …”