Extracorporeal life support and plasmapheresis in a case of severe polyintoxication.
J Emerg Med
; 47(5): 527-31, 2014 Nov.
Article
em En
| MEDLINE
| ID: mdl-25220022
ABSTRACT
BACKGROUND:
Resuscitation without return to spontaneous circulation in patients with suicidal ingestion of cardiotoxic drugs necessitates alternative bridging therapies for drug removal.OBJECTIVES:
To show the effectiveness of emergency extracorporeal membrane oxygenation (ECMO) and plasmaspheresis in severe polyintoxication. CASE REPORT A 21-year-old woman developed asystole after suicidal polyintoxication with 1.75 g carvedilol, 300 mg amlodipine, 6 g amitriptyline, 500 mg torsemide, 1.5 g ketoprofen, 28 g nicotinic acid, and 16 g gabapentin. After 3 h of cardiopulmonary resuscitation without return to spontaneous circulation, ECMO was used as a bridging therapy and a temporary pacemaker was inserted. Plasma peak levels were measured for amlodipine (29.3 µg/L), amitriptyline (1456 µg/L), carvedilol (585 µg/L), and gabapentin (126.8 mg/L). To facilitate drug removal, therapeutic plasma exchange was performed. The patient could be weaned from ECMO at day 4 and extubated on day 8 after admission without neurologic sequelae.CONCLUSION:
ECMO and plasma exchange should be considered as a therapeutic option in selected patients under resuscitation without return to spontaneous circulation after severe intoxication.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Tentativa de Suicídio
/
Oxigenação por Membrana Extracorpórea
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Plasmaferese
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Anti-Hipertensivos
Limite:
Adult
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Female
/
Humans
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article