title: Extracorporeal life support in a case of acute carbamazepine poisoning with life-threatening refractory myocardial failure.
abstract: 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.
authors.affiliation: AP-HP, Hôpital Lariboisière, Réanimation Médicale et Toxicologique, INSERM U705, CNRS, UMR 7157, Université Paris VII, 2 Rue Ambroise Paré, 75010 Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Mégarbane
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.forename: Gilles
authors.initials: G
authors.lastname: Guerrier
authors.forename: Dabor
authors.initials: D
authors.lastname: Résière
authors.forename: Vanessa
authors.initials: V
authors.lastname: Bloch
authors.forename: Frédéric J
authors.initials: FJ
authors.lastname: Baud
mesh_terms: 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
chemical_list: D002220:Carbamazepine