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

Local Anesthetic Systemic Toxicity Induced Cardiac Arrest After Topicalization for Transesophageal Echocardiography and Subsequent Treatment With Extracorporeal Cardiopulmonary Resuscitation

“…In patients with cardiopulmonary instability despite intralipid, consideration should be given to alerting the nearest facility capable of extracorporeal life support (ECLS). The use of extracorporeal life support ECLS—most commonly VA-ECMO—for cardiopulmonary collapse due to medication overdose has been well described (11–13), and appears to be cost effective (14), though large series are limited (15). In a recent review of emergency department ECMO for cardiopulmonary collapse due to cardio toxic drugs by Johnson et al , the most common medications were calcium channel blockers and antiarrhythmics (16).…”

Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers

“…ILE may be not effective with less lipophilic beta blockers such as metoprolol compared with propranolol 8,[21][22][23] . However, in case of metoprololinduced cardiac arrest refractory to standard treatment, combination of high-dose insulin, lipid emulsion and venoarterial extracorporeal membrane oxygenation was successful rescue therapy 24 . On the other side, ILE was not effective in reversal of metoprolol-induced hypotension in rabbit model 25 .…”

Extracorporeal life support: The final ‘antidote’ for massive propranolol overdose

“…The reluctance to initiate ECLS may be related to the high complication rate or the huge resources needed. [16][17][18] Late initiation of ECLS often means increased stress during insertion of the vascular cannulas. Resuscitation scenarios have been shown to be associated with a higher failure rate of cannula insertion.…”