title: Survival After Cardiac Arrest: ECMO Rescue Therapy After Amlodipine and Metoprolol Overdose.
abstract: Extracorporeal membrane oxygenation (ECMO) use in poisoned patients is increasing, but is rare post cardiac arrest. We report a case of ECMO use with complete recovery in a patient who arrested twice after a cardiotoxicant overdose. A 17-year-old male presented after an unknown overdose. He rapidly became hypotensive and bradycardic and received aggressive supportive care without improvement. He was transferred to our institution and suffered a cardiac arrest shortly after arrival. Six minutes of advanced cardiac life support resulted in return of spontaneous circulation. High-dose insulin, lipid emulsion, and ECMO were initiated. While awaiting ECMO deployment, he again became pulseless. Compressions resumed, and after 30 min, ROSC was achieved, and he was cannulated for veno-arterial ECMO. Within 48 h, he was decannulated, and then weaned off epinephrine 2 days later. Upon extubation, he was neurologically intact. Amlodipine and metoprolol were later confirmed in serum. Adolescent poisoned patients represent an ideal population for ECMO due to lack of comorbidities. As experience with ECMO in overdose increases, additional research is needed to determine appropriate indications and timing for its use. ECMO is an option for patients poisoned with a cardiotoxicant drug, even following witnessed cardiac arrest.
authors.affiliation: Department of Emergency Medicine, Virginia Commonwealth University Health System, 830 E. Main St, STE 300, Richmond, VA, 23219, USA. Kevin.maskell@vcuhealth.org.
authors.forename: Kevin F
authors.identifier: 0000-0002-4545-8694
authors.initials: KF
authors.lastname: Maskell
authors.affiliation: Department of Pediatrics, Virginia Commonwealth University Health System, Richmond, VA, 23219, USA.
authors.forename: Nikki Miller
authors.initials: NM
authors.lastname: Ferguson
authors.affiliation: Department of Pediatrics, Virginia Commonwealth University Health System, Richmond, VA, 23219, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Bain
authors.affiliation: Department of Emergency Medicine, Virginia Commonwealth University Health System, 830 E. Main St, STE 300, Richmond, VA, 23219, USA.
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Wills
mesh_terms: D000293:Adolescent; D058671:Adrenergic beta-1 Receptor Antagonists / Q000506:poisoning*; D017311:Amlodipine / Q000506:poisoning*; D002121:Calcium Channel Blockers / Q000506:poisoning*; D062787:Drug Overdose; D015199:Extracorporeal Membrane Oxygenation; D006323:Heart Arrest / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000506:poisoning*; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D002121:Calcium Channel Blockers; D017311:Amlodipine; D008790:Metoprolol
keywords: Beta-blocker poisoning; Calcium channel blocker poisoning; Extracorporeal membrane oxygenation; Pediatric overdose