title: Two Cases of Refractory Cardiogenic Shock Secondary to Bupropion Successfully Treated with Veno-Arterial Extracorporeal Membrane Oxygenation.
abstract: Bupropion inhibits the uptake of dopamine and norepinephrine. Clinical effects in overdose include seizure, status epilepticus, tachycardia, arrhythmias, and cardiogenic shock. We report two cases of severe bupropion toxicity resulting in refractory cardiogenic shock, cardiac arrest, and repeated seizures treated successfully. Patients with cardiovascular failure related to poisoning may particularly benefit from extracorporeal membrane oxygenation (ECMO). These are the first cases of bupropion toxicity treated with veno-arterial EMCO (VA-ECMO) in which bupropion toxicity is supported by confirmatory testing. Both cases demonstrate the effectiveness of VA-ECMO in poisoned patients with severe cardiogenic shock or cardiopulmonary failure.
authors: Center for Toxicology and Pharmacology Education and Research, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA. craig.heise@bannerhealth.com.|Department of Medical Toxicology, Banner University Medical Center Phoenix, 925 E. McDowell Road, 2nd Floor Medical Toxicology, Phoenix, AZ, 85006, USA. craig.heise@bannerhealth.com.
authors: C William
authors: CW
authors: Heise
authors: Department of Medical Toxicology, Banner University Medical Center Phoenix, 925 E. McDowell Road, 2nd Floor Medical Toxicology, Phoenix, AZ, 85006, USA.
authors: Aaron B
authors: AB
authors: Skolnik
authors: Department of Medicine, Section of Critical Care, Banner University Medical Center Phoenix, Phoenix, AZ, USA.
authors: Robert A
authors: RA
authors: Raschke
authors: Department of Medicine, Section of Critical Care, Banner University Medical Center Phoenix, Phoenix, AZ, USA.
authors: Huw
authors: H
authors: Owen-Reece
authors: Department of Medical Toxicology, Banner University Medical Center Phoenix, 925 E. McDowell Road, 2nd Floor Medical Toxicology, Phoenix, AZ, 85006, USA.
authors: Kimberlie A
authors: KA
authors: Graeme
mesh_terms: D000293:Adolescent; D018687:Antidepressive Agents, Second-Generation / Q000506:poisoning*; D001130:Arizona; D016642:Bupropion / Q000506:poisoning*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D062787:Drug Overdose / Q000503:physiopathology* / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D013226:Status Epilepticus / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D013406:Suicide, Attempted; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion
keywords: Bupropion; Cardiogenic shock; ECMO; Extracorporeal membrane oxygenation; Overdose; Status epilepticus