Extracorporeal life support in a case of acute carbamazepine poisoning with life-threatening refractory myocardial failure.
OBJECTIVE
To report the efficacy of extracorporeal life support (ECLS) in acute carbamazepine poisoning with sustained refractory myocardial failure and a high degree of conductance disturbances.


METHODS
Case report from the toxicological and medical intensive care unit in a university hospital.


METHODS
A 26-year-old man with severe myocardial failure unresponsive to 1.7 microg kg(-1) min(-1) epinephrine and 1.9 microg kg(-1) min(-1) norepinephrine (SvO2, 17.8% and cardiac index, 0.8 l min(-1) m(-2)) following a suicidal ingestion of 32 g slow-release carbamazepine.


METHODS
ECLS (Jostra-Maquet centrifugal pump (Rotaflow) connected to a hollow-fiber membrane oxygenator).


RESULTS
ECLS device allowed inotropic drug weaning while maintaining end-organ function and supported the patient until myocardial recovery. The plasma carbamazepine level was 224 micromol/l on admission and peaked at 338 micromol/l 101 h after admission with a prolonged gastrointestinal absorption phase despite multiple doses of activated charcoal. The patient survived and was successfully explanted on day 6. An extensive and regressive thrombosis of the inferior vena cava was noted. Cardiac function totally recovered and at 2-year follow-up. There were no significant sequelae.


CONCLUSIONS
We report a case of life-threatening myocardial failure with conductance disturbances secondary to an acute carbamazepine poisoning, demonstrating the efficacy of ECLS to assist recovery.
Mégarbane
Bruno
B
AP-HP, Hôpital Lariboisière, Réanimation Médicale et Toxicologique, INSERM U705, CNRS, UMR 7157, Université Paris VII, 2 Rue Ambroise Paré, 75010 Paris, France.
Leprince
Pascal
P
Deye
Nicolas
N
Guerrier
Gilles
G
Résière
Dabor
D
Bloch
Vanessa
V
Baud
Frédéric J
FJ
D000328:Adult; D053840:Brugada Syndrome / Q000139:chemically induced* / Q000628:therapy*; D002220:Carbamazepine / Q000506:poisoning*; D004562:Electrocardiography; D015199:Extracorporeal Membrane Oxygenation; D006329:Heart Conduction System / Q000187:drug effects*; D006801:Humans; D008020:Life Support Care; D008297:Male; D013406:Suicide, Attempted
D002220:Carbamazepine