Comparative resuscitation measures for the treatment of desipramine overdose.
A toxic dose of desipramine (tricyclic antidepressant) causes cardiac arrhythmias and ultimately asystole. Resuscitation is difficult and almost always unsuccessful. Anecdotal evidence suggests that an infusion of lipid emulsion may be an effective treatment. The purpose of this study was to determine the optimal combination of lipid rescue and traditional Advanced Cardiac Life Support therapy for the treatment of desipramine overdose. We use a prospective, experimental, between subjects design with a swine model investigating the effectiveness of the drugs and drug combinations administered with cardiopulmonary resuscitation. Subjects were randomly assigned to 1 of 8 cardiopulmonary resuscitation/drug combination interventions, and the results from each group were compared using an analysis of variance and post hoc Tukey where appropriate. The groups that received vasopressin were more likely to survive than those that did not receive vasopressin, and the groups that received lipid emulsion were more likely to survive than those that did not receive lipid emulsion. Vasopressin alone was shown to be the most effective treatment in the management of desipramine overdose. The results of this study may warrant changes in treatment protocols for desipramine overdose.
Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, 3490 Forage Road, San Antonio, TX 78234.
Joseph C
JC
O'Sullivan
Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, 3490 Forage Road, San Antonio, TX 78234.
Arthur D
AD
Johnson
CR Darnall Medical Center, 36000 Darnall Loop, Fort Hood, TX 76544.
Melissa A
MA
Waterman
D000322:Adrenergic Agonists / Q000627:therapeutic use; D022561:Advanced Cardiac Life Support / Q000379:methods; D000818:Animals; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D050034:Antidiuretic Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D003891:Desipramine / Q000506:poisoning*; D004195:Disease Models, Animal; D062787:Drug Overdose / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods; D004837:Epinephrine / Q000627:therapeutic use; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D006336:Heart Massage / Q000379:methods; D006339:Heart Rate / Q000502:physiology; D008297:Male; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods*; D015996:Survival Rate; D013552:Swine; D014667:Vasopressins / Q000627:therapeutic use
D000322:Adrenergic Agonists; D000929:Antidepressive Agents, Tricyclic; D050034:Antidiuretic Agents; D005217:Fat Emulsions, Intravenous; D014667:Vasopressins; D003891:Desipramine; D004837:Epinephrine