title: Is the intra-aortic balloon pump a method of brain protection during cardiogenic shock after drug intoxication?
abstract: Cardiovascular medications are ubiquitous and are frequently implicated in accidental or intentional overdose. It is common that combined use of these drugs may lead to hypotension and even shock, followed by metabolic derangements. We report a case in which an intra-aortic balloon pump (IABP) was used in the management of self-poisoning with verapamil, amlodipine, metoprolol, and ibuprofen. In presenting this case of combined massive drug ingestion, we outline early strategy in the Emergency Department and some alternative treatment options. Beyond pharmacological and conservative procedures, we implemented an invasive approach that included temporary pacing, mechanical ventilation, and intra-aortic balloon counterpulsation (IABP). Such intense treatment was necessary due to the critical state of the patient. In our opinion, the use of the IABP contributed to the final recovery of our adolescent patient. Combined mechanical and pharmacological treatment may protect from multi-organ insufficiency, including permanent central nervous system injury. It is hoped that reporting our experience will raise awareness of alternative treatment options for ingestions of cardiovascular medications.
authors.affiliation: Department of Cardiology, Swietokrzyskie Centrum Kardiologii, Kielce, Poland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Janion
authors.forename: Aleksander
authors.initials: A
authors.lastname: Stepień
authors.forename: Janusz
authors.initials: J
authors.lastname: Sielski
authors.forename: Wojciech
authors.initials: W
authors.lastname: Gutkowski
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000506:poisoning*; D017311:Amlodipine / Q000506:poisoning*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000506:poisoning*; D001927:Brain Diseases / Q000517:prevention & control*; D002121:Calcium Channel Blockers / Q000506:poisoning*; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000506:poisoning*; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D008790:Metoprolol / Q000506:poisoning*; D012770:Shock, Cardiogenic / Q000139:chemically induced* / Q000628:therapy*; D013406:Suicide, Attempted / Q000523:psychology; D014700:Verapamil / Q000506:poisoning*
chemical_list: D000319:Adrenergic beta-Antagonists; D000894:Anti-Inflammatory Agents, Non-Steroidal; D002121:Calcium Channel Blockers; D017311:Amlodipine; D014700:Verapamil; D008790:Metoprolol; D007052:Ibuprofen