Rescue Extracorporeal Life Support for Acute Verapamil and Propranolol Toxicity in a Neonate

Rita, Fabrizio De; Barozzi, Luca; Franchi, Gianluigi; Faggian, Giuseppe; Mazzucco, Alessandro; Luciani, Giovanni Battista

doi:10.1111/j.1525-1594.2010.01134.x

Cited by 15 publications

(8 citation statements)

References 13 publications

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“…ECMO in the pediatric population has become standard of care not only for short-term bridge to recovery (9), to other bridging devices, and to transplantation, but also as bridge to repair (10), to therapy (11), and finally as a bridge to diagnosis, in selected cases (12). Indications have expanded considerably through the years, including support for respiratory distress syndrome, multisystem organ failure, burns, traumatic hemorrhage, sepsis, myocarditis, malignant arrhythmias, and circulatory support after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Indications have expanded considerably through the years, including support for respiratory distress syndrome, multisystem organ failure, burns, traumatic hemorrhage, sepsis, myocarditis, malignant arrhythmias, and circulatory support after cardiac surgery. ECMO in the pediatric population has become standard of care not only for short-term bridge to recovery (9), to other bridging devices, and to transplantation, but also as bridge to repair (10), to therapy (11), and finally as a bridge to diagnosis, in selected cases (12). Although outcome after mechanical life support using V-A ECMO for acute cardiac failure in children has improved dramatically over the last decade, there remains significant room for improvement.…”

Section: Discussionmentioning

confidence: 99%

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Improved Outcome of Cardiac Extracorporeal Membrane Oxygenation in Infants and Children Using Magnetic Levitation Centrifugal Pumps

et al. 2015

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Extracorporeal membrane oxygenation (ECMO) has traditionally been and, for the most part, still is being performed using roller pumps. Use of first-generation centrifugal pumps has yielded controversial outcomes, perhaps due to mechanical properties of the same and the ensuing risk of hemolysis and renal morbidity. Latest-generation centrifugal pumps, using magnetic levitation (ML), exhibit mechanical properties which may have overcome limitations of first-generation devices. This retrospective study aimed to assess the safety and efficacy of veno-arterial (V-A) ECMO for cardiac indications in neonates, infants, and children, using standard (SP) and latest-generation ML centrifugal pumps. Between 2002 and 2014, 33 consecutive neonates, infants, and young children were supported using V-A ECMO for cardiac indications. There were 21 males and 12 females, with median age of 29 days (4 days-5 years) and a median body weight of 3.2 kg (1.9-18 kg). Indication for V-A ECMO were acute circulatory collapse in ICU or ward after cardiac repair in 16 (49%) patients, failure to wean after repair of complex congenital heart disease in 9 (27%), fulminant myocarditis in 4 (12%), preoperative sepsis in 2 (6%), and refractory tachy-arrhythmias in 2 (6%). Central cannulation was used in 27 (81%) patients and peripheral in 6. Seven (21%) patients were supported with SP and 26 (79%) with ML centrifugal pumps. Median duration of support was 82 h (range 24-672 h), with 26 (79%) patients weaned from support. Three patients required a second ECMO run but died on support. Seventeen (51%) patients required peritoneal dialysis for acute renal failure. Overall survival to discharge was 39% (13/33 patients). All patients with fulminant myocarditis and with refractory arrhythmias were weaned, and five (83%) survived, whereas no patient supported for sepsis survived. Risk factors for hospital mortality included lower (<2.5 kg) body weight (P = 0.02) and rescue ECMO after cardiac repair (P = 0.03). During a median follow-up of 34 months (range 4-62 months), there were three (23%) late deaths and two late survivors with neurological sequelae. Weaning rate (5/7 vs. 21/26, P = NS) and prevalence of renal failure requiring dialysis (4/7 vs. 13/26, P = NS) were comparable between SP and ML ECMO groups. Patients supported with ML had a trend toward higher hospital survival (1/7 vs. 12/26, P = 0.07) and significantly higher late survival (0/7 vs. 10/26, P = 0.05). The present experience shows that V-A ECMO for cardiac indications using centrifugal pumps in infants and children yields outcomes absolutely comparable to international registry (ELSO) data using mostly roller pumps. Although changes in practice may have contributed to these results, use of ML centrifugal pumps appears to further improve end-organ recovery and hospital and late survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improved Outcome of Cardiac Extracorporeal Membrane Oxygenation in Infants and Children Using Magnetic Levitation Centrifugal Pumps

et al. 2015

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“…In two patients, CCB poisoning was associated with verapamil in combination with the nonselective beta-blocker propranolol. ECMO cannulation occurred at 4 and 10 hours after intoxication and both patients survived to hospital discharge [13, 14]. The third pediatric case reported is of a 16-year-old female with an acute intentional ingestion of 12 grams of sustained release diltiazem.…”

Section: Discussionmentioning

confidence: 99%

Circulatory Support with Venoarterial ECMO Unsuccessful in Aiding Endogenous Diltiazem Clearance after Overdose

Frazee

Lee

Kalimullah

et al. 2014

Case Reports in Critical Care

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Introduction. In cardiovascular collapse from diltiazem poisoning, extracorporeal membrane oxygenation (ECMO) may offer circulatory support sufficient to preserve endogenous hepatic drug clearance. Little is known about patient outcomes and diltiazem toxicokinetics in this setting. Case Report. A 36-year-old woman with a history of myocardial bridging syndrome presented with chest pain for which she self-medicated with 2.4 g of sustained release diltiazem over the course of 8 hours. Hemodynamics and mentation were satisfactory on presentation, but precipitously deteriorated after ICU transfer. She was given fluids, calcium, vasopressors, glucagon, high-dose insulin, and lipid emulsion. Due to circulatory collapse and multiorgan failure including ischemic hepatopathy, she underwent transvenous pacing and emergent initiation of venoarterial ECMO. The peak diltiazem level was 13150 ng/mL (normal 100–200 ng/mL) and it remained elevated at 6340 ng/mL at hour 90. Unfortunately, the patient developed multiple complications which resulted in her death on ICU day 9. Conclusion. This case describes the unsuccessful use of ECMO for diltiazem intoxication. Although past reports suggest that support with ECMO may facilitate endogenous diltiazem clearance, it may be dependent on preserved hepatic function at the time of cannulation, a factor not present in this case.

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“…ILE has been benefi cial in a case report and may be considered following routine therapy [ 124 ]. When all else fails, temporary pacing may be attempted and ECMO has previously been life-saving [ 131 ].…”

Section: Beta-blockers (β-Blockers)mentioning

confidence: 98%

Toxic Ingestions

Sullivan

McDonald

2014

Pediatric Critical Care Medicine

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IntroductionEven with public heightened awareness for potential home toxin exposures, poisonings continue to occur and pose a signifi cant challenge to the pediatric intensivist. In 2009, United States Poison Control centers reported 1,613,272 toxin exposures in children less than 20 years of age [ 1 ]. This represented 65 % of all reported human exposures. Children younger than 3 years were involved in 38.9 % of exposures and children younger than 6 years accounted for just over half of all human exposures (51.9 %). The three most common exposures in children age 5 years or younger were cosmetics/personal care products (13.0 %), analgesics (9.7 %), and household cleaning substances (9.3 %). Despite the majority of human exposures being in the pediatric age group, only 79 (6.8 %) of the 1,158 human deaths were in those less than 20 years of age. As expected, unintentional toxin exposures were more prevalent in children younger than 13 years of age (99.2 %) compared to teenagers (47 %) [ 1 ]. The intensivist must be prepared to care for the children who have serious and sometimes life-threatening exposures. AbstractDespite the public's heightened awareness of potential toxin exposures in children, poisonings continue to occur and pose a signifi cant challenge to the pediatric intensivist. In 2009, the United States Poison Control centers reported 1,613,272 toxin exposures in children less than 20 years of age which represented 65 % of all reported human exposures. Children younger than 3 years were involved in 38.9 % and children younger than 6 years accounted for just over half of all human exposures (51.9 %). The three most common exposures in children age 5 years or younger were cosmetics/personal care products (13.0 %), analgesics (9.7 %), and household cleaning substances (9.3 %). Despite the majority of human exposures being in the pediatric age group, only 79 (6.8 %) of the 1,158 human deaths were in those less than 20 years of age. As expected, unintentional toxin exposures were more prevalent in children younger than 13 years of age (99.2 %) compared to teenagers (47 %). The intensivist must be prepared to care for children who have serious and sometimes life-threatening exposures. Supportive care is the mainstay of therapy because many poisons have no specifi c antidote. Much of the current clinical practices for treating the poisoned patient are based on anecdotal reports because there are limited evidenced-based clinical trials that provide guidance for treatment, safety, and outcome.

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Rescue Extracorporeal Life Support for Acute Verapamil and Propranolol Toxicity in a Neonate

Cited by 15 publications

References 13 publications

Improved Outcome of Cardiac Extracorporeal Membrane Oxygenation in Infants and Children Using Magnetic Levitation Centrifugal Pumps

Improved Outcome of Cardiac Extracorporeal Membrane Oxygenation in Infants and Children Using Magnetic Levitation Centrifugal Pumps

Circulatory Support with Venoarterial ECMO Unsuccessful in Aiding Endogenous Diltiazem Clearance after Overdose

Toxic Ingestions

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