Enoximone in cardiac arrest caused by propranolol: two case reports.
We report two clinical cases of cardiac arrest, the former due to an adverse effect of intravenous (i.v.) propranolol in a patient with systemic sclerosis, the latter from a propranolol suicidal overdose. In both cases, conventional advanced life support (ALS) was ineffective but both patients eventually responded to the administration of enoximone, a phosphodiesterase III (PDE III) inhibitor. After the arrest, both patients regained consciousness and were discharged home. The chronotropic and inotropic effects of PDE III inhibitors are due to inhibition of intracellular PDEIII and are therefore unaffected by beta-blockers. These cases suggest that PDEIII inhibitors may be useful in restoring spontaneous circulation in cardiac arrest associated with beta-blocker administration when standard ALS is ineffective.
Sandroni
C
C
Department of Anesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy. sandroni@rm.unicatt.it
Cavallaro
F
F
Caricato
A
A
Scapigliati
A
A
Fenici
P
P
Antonelli
M
M
D000319:Adrenergic beta-Antagonists / Q000506:poisoning*; D000328:Adult; D022561:Advanced Cardiac Life Support; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D062787:Drug Overdose; D017335:Enoximone / Q000627:therapeutic use*; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced* / Q000188:drug therapy*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011433:Propranolol / Q000506:poisoning*; D013406:Suicide, Attempted
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D011433:Propranolol; D017335:Enoximone