Propofol infusion syndrome resuscitation with extracorporeal life support: a case report and review of the literature

Abstract

We report a case of propofol infusion syndrome (PRIS) in a young female treated for status epilepticus. In this case, PRIS rapidly evolved to full cardiovascular collapse despite aggressive supportive care in the intensive care unit, as well as prompt discontinuation of the offending agent. She progressed to refractory cardiac arrest requiring emergent initiation of venoarterial extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR). She regained a perfusing rhythm after prolonged (>8 hours) asystole, was weaned off ECMO and eventually all life support, and was discharged to home. We also present a review of the available literature on the use of ECMO for PRIS.

Systemic complications of status epilepticus — An update

“…When used in high doses for 3 days or more, propofol can cause a syndrome of metabolic acidosis, rhabdomyolysis, lactic acidosis, lipemia, hyperkalemia, renal failure, and rapid cardiovascular collapse. Once the syndrome begins, there is no good treatment other than to stop the propofol and support the cardiopulmonary and renal systems with renal replacement therapy, cardiac pacing, and, sometimes, extracorporal membrane oxygenation [25]. The risk of this feared complication is higher at doses N5 mg/kg/h, and risk factors include younger age, high fat and low carbohydrate intake, concomitant catecholamine infusion, and concomitant corticosteroid use [26,27].…”

Propofol infusion syndrome

“…4,5 Propofol is an ultra-short-acting I.V. 7 In a large prospective study conducted in 2008, 1,017 patients from 11 ICUs who were suspected of having PRIS were observed. 6 Its rapid onset and elimination allow for quick weaning and neurologic assessments.…”

“…Though successful resuscitation with extracorporeal membrane oxygenation has been described in a case report, 7 currently there are no definitive treatment guidelines apart from prompt discontinuation of propofol and supportive care. Though successful resuscitation with extracorporeal membrane oxygenation has been described in a case report, 7 currently there are no definitive treatment guidelines apart from prompt discontinuation of propofol and supportive care.…”

Therapeutic plasma exchange as treatment for propofol infusion syndrome

“…There is no specific diagnostic test or treatment. Hemofiltration and extracorporeal membrane oxygenation (ECMO) have been attempted , however mortality remains high, up to 64% .…”