Successful resuscitation of a verapamil-intoxicated patient with percutaneous cardiopulmonary bypass

Hölzer, Michael; Sterz, Fritz; Schoerkhuber, Waltraud; Behringer, Wilhelm; Domanovits, Hans; Weinmar, Dagmar; Weinstabl, C.; Stimpfl, Thomas

doi:10.1097/00003246-199912000-00035

Cited by 87 publications

(35 citation statements)

References 18 publications

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“…These early studies showed improved mortality in models of lidocaine and amitriptyline poisoning [11,12]. Numerous human case reports and case series have since shown favorable outcomes although ECMO has been primarily used in poisonings involving pharmaceuticals such as antidysrhythmics and other cardiovascular medications, as well as tricyclic antidepressants [13][14][15][16][17][18][19][20][21][22][23][24][25]. Many of the pharmaceutical exposures in our cohort were similar to cases reported in the literature with most leading to cardiotoxicity or hemodynamic collapse (flecainide, diphenhydramine, and verapamil).…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

et al. 2015

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Although there have been many developments related to specific strategies for treating patients after poisoning exposures, the mainstay of therapy remains symptomatic and supportive care. One of the most aggressive supportive modalities is extracorporeal membrane oxygenation (ECMO). Our goal was to describe the use of ECMO for toxicological exposures reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (Tox-IC). We performed a retrospective review of the ACMT ToxIC Registry from January 1, 2010 to December 31, 2013. Inclusion criteria included patients aged 0 to 89 years, evaluated between January 2010 through December 2013, and received ECMO for toxicological exposure. There were 26,271 exposures (60 % female) reported to the ToxIC Registry, 10 (0.0004 %) received ECMO: 4 pediatric (< 12 years), 2 adolescent (12-18 years), and 4 adults (>18 years). Time of initiation of ECMO ranged from 4 h to 4 days, with duration from 15 h to 12 days. Exposures included carbon monoxide/smoke inhalation (2), bitter almonds, methanol, and several medications including antihistamines (2), antipsychotic/ antidepressant (2), cardiovascular drugs (2), analgesics (2), sedative/hypnotics (2), and antidiabetics (2). Four ECMO patients received cardiopulmonary resuscitation (CPR) during their hospital course, and the overall survival rate was 80 %. ECMO was rarely used for poisoning exposures in the ACMT ToxIC Registry. ECMO was utilized for a variety of ages and for pharmaceutical and non-pharmaceutical exposures. In most cases, ECMO was administered prior to cardiovascular failure, and survival rate was high. If available, ECMO may be a valid treatment modality.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

et al. 2015

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“…Other treatments that were mentioned in the articles as being potentially beneficial but that would not likely be available to, or practicable for, U.S. out-ofhospital personnel are not listed in the table. These include dexamethasone (81), methylscopolamine (91), metaproterenol (66,139), 4-aminopyridine (134), amrinone (96,138), angiotensin II (25), theophylline (139), enoxamine (73), and vasopressin (112). General supportive care measures (e.g., airway management measures, fluids, anticonvulsants, bicarbonate) might have been beneficial in some cases but were difficult to evaluate and are not specifically addressed in the table or this summary.…”

Section: Other Treatmentsmentioning

confidence: 99%

Calcium Channel Blocker Ingestion: An Evidence-Based Consensus Guideline for Out-of-Hospital Management

Olson

Erdman

Woolf

et al. 2005

Clinical Toxicology

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“…Extracorporeal life support has shown a good survival outcome in at least one case report of verapamil toxicity83 and three observational studies that also involve other cardiotoxic drugs 84–86. Unfortunately, such an invasive procedure is not without side effects.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological and mechanical management of calcium channel blocker toxicity

Fadhlillah¹,

Patil

2018

BMJ Case Reports

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Cardiovascular instability associated with calcium channel blocker toxicity comprises a small percentage of overdose presentations, yet they are associated with a high mortality rate. We detail the management of a 64-year-old man who took an intentional overdose of 840 mg nimodipine. We include the treatment he received and highlight the scarcity of evidence behind the use of gastric decontamination, calcium, glucagon, intravenous lipid emulsion, high-dose insulin therapy, sodium bicarbonate, vasopressors and methylene blue in calcium channel blocker toxicity. Additionally, the article explores the use of electrical pacing and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Following successful weaning of VA-ECMO, the patient was successfully extubated but remained neurologically impaired due to hypoxic-ischaemic brain injury, critical care polyneuropathy and renal failure requiring dialysis. He has cerebral performance category 3; he has mild cognitive impairment but able to perform some activities of daily living independently and communicate his thoughts and needs. He requires no respiratory or cardiovascular support.

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Successful resuscitation of a verapamil-intoxicated patient with percutaneous cardiopulmonary bypass

Cited by 87 publications

References 18 publications

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

Calcium Channel Blocker Ingestion: An Evidence-Based Consensus Guideline for Out-of-Hospital Management

Pharmacological and mechanical management of calcium channel blocker toxicity

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