title: Venoarterial extracorporeal membrane oxygenation for the management of massive amlodipine overdose.
abstract: A 50-year-old man was admitted to the intensive care unit with respiratory failure and shock after suffering a massive overdose of amlodipine, lisinopril and hydrochlorothiazide. Despite mechanical ventilation, vasopressors, calcium gluconate, hyperinsulinemia-euglycemia therapy, methylene blue and intravenous fat emulsion, the patient's respiratory and hemodynamic status deteriorated. Venoarterial extracorporeal membrane oxygenation (ECMO) was initiated to provide cardiopulmonary support in the setting of profound respiratory failure and refractory shock. The patient was placed on ECMO 19 hours after arrival to the hospital, after which vasopressor and ventilatory requirements decreased significantly. The patient was decannulated from ECMO after 8 days and was discharged home after a 56-day hospitalization. Early institution of ECMO should be considered for the management of respiratory failure and refractory shock in the setting of calcium channel blocker overdose when medical therapies are insufficient.
authors.affiliation: 1Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, Division of Cardiology, Department of Medicine, New York, NY, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Weinberg
authors.forename: N C
authors.initials: NC
authors.lastname: Bouchard
authors.forename: D C
authors.initials: DC
authors.lastname: Abrams
authors.forename: M
authors.initials: M
authors.lastname: Bacchetta
authors.forename: A L
authors.initials: AL
authors.lastname: Dzierba
authors.forename: K M
authors.initials: KM
authors.lastname: Burkart
authors.forename: D
authors.initials: D
authors.lastname: Brodie
mesh_terms: D017311:Amlodipine / Q000506:poisoning*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D006852:Hydrochlorothiazide / Q000506:poisoning*; D017706:Lisinopril / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D006852:Hydrochlorothiazide; D017311:Amlodipine; D017706:Lisinopril
keywords: ECMO; amlodipine; overdose; respiratory failure; shock