Cardiac arrest due to baclofen withdrawal syndrome.
A 41-year-old man presented with postcervical traumatic complete quadriparesis under intrathecal baclofen therapy (ITB) for refractory spasticity. Less than 24 h after having his baclofen pump substituted, he develops hyperthermia, seizures, cognitive depression, acute hypoxaemic respiratory failure and cardiovascular instability leading to mechanical ventilation and vasopressor support. He was transferred to an intensive care unit with diagnosis of community-acquired pneumonia leading to septic shock. He evolved with progressive clinical worsening and multisystem organ failure and cardiac arrest in non-shockable rhythm (pulseless electrical activity)--4 min resuscitation with return of spontaneous circulation. Considering the possible diagnosis of baclofen withdrawal syndrome and, in suspicion of ITB delivery disruption, the catheter system was surgically explored and a leaking tubule attachment was found. Despite aggressive cardiovascular, respiratory and renal support therapy, clinical improvement occurred only after restoration of intrathecal drug delivery. He was discharged from the hospital after 56 days, having returned to baseline status.
Department of Anesthesiology, Centro Hospitalar do Porto EPE, Porto, Portugal.
Ana Luísa
AL
Cardoso
Department of Internal Medicine of Hospital Distrital da Figueira da Foz EPE, Figueira da Foz, Portugal.
Claudio
C
Quintaneiro
Department of Anesthesiology, Centro Hospitalar do Porto EPE, Porto, Portugal.
Helena
H
Seabra
Unidade de Cuidados Intensivos Polivalente do Centro Hospitalar do Porto EPE, Porto, Portugal.
Carla
C
Teixeira
D000328:Adult; D001418:Baclofen / Q000009:adverse effects* / Q000627:therapeutic use; D004868:Equipment Failure; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000009:adverse effects / Q000627:therapeutic use; D009128:Muscle Spasticity / Q000188:drug therapy*; D011782:Quadriplegia / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome
D009125:Muscle Relaxants, Central; D001418:Baclofen