Chlorhexidine-related refractory anaphylactic shock: a case successfully resuscitated with extracorporeal membrane oxygenation.
OBJECTIVE
We report a patient with a life-threatening anaphylactic reaction to a chlorhexidine-coated central venous catheter, confirmed with a high serum level of chlorhexidine-specific IgE. To our knowledge, this is the first case successfully resuscitated using extracorporeal membrane oxygenation (ECMO). Great caution is required when using chlorhexidine and chlorhexidine-impregnated catheters, given that its widespread use has the potential to sensitize certain patients and may result in life-threatening anaphylaxis on subsequent exposure.


METHODS
A case report of a single patient with life-threatening anaphylactic shock to chlorhexidine, who was successfully resuscitated using ECMO.


CONCLUSIONS
We have designed a flowchart for the diagnosis and management of severe anaphylaxis. This case report highlights the potential for chlorhexidine to be a source for the development of refractory anaphylactic shock. We suggest that ECMO may save the lives of patients with severe bronchospasm and refractory anaphylactic shock secondary to chlorhexidine.
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Man-Ling
ML
Wang
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Ching-Tao
CT
Chang
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Hsing-Hao
HH
Huang
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Yu-Chang
YC
Yeh
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Tzong-Shiun
TS
Lee
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: ntuhkyhung@gmail.com.
Kuan-Yu
KY
Hung
D000707:Anaphylaxis / Q000097:blood / Q000139:chemically induced / Q000628:therapy*; D000768:Anesthesia, General; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002710:Chlorhexidine / Q000009:adverse effects / Q000276:immunology*; D002812:Chondroma / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods*
D000891:Anti-Infective Agents, Local; D007073:Immunoglobulin E; D002710:Chlorhexidine
Anaphylaxis; Central venous catheters; Chlorhexidine; Extracorporeal membrane oxygenation