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Citation |
Lang JH, Sotoudeh R, Douwa R, Bojara W, Sakka SG. Anasthesiologie und Intensivmedizin 2021; 62(5): 236-239. |
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Copyright |
(Copyright © 2021) |
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DOI |
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PMID |
unavailable |
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Abstract |
The use of an extracorporeal heart-lung support system (i.e., extracorporeal life support, ECLS) is mainly reserved for the treatment of patients with acute cardiogenic shock due to myocardial failure. Several reports exist on the use of ECLS in the treatment of patients with intoxications from cardiotoxic drugs. More recently, use of ECLS has been reported in the treatment of patients in shock resulting from intoxications with drugs without primarily compromising cardiac function. In our case, ECLS was applied due to a distributive shock difficult to control, after an intoxication with potent vasoactive drugs, in order to maintain an adequate perfusion pressure by increasing cardiac output. We describe a 26-year old male who attempted suicide by swallowing 700 mg ramipril and 500 mg amlodipine. Consequently, over several hours, a massive drop in systemic vascular resistance developed. Unfortunately, treatment with norepinephrine, dobutamine and vasopressin analogues, despite a hypercontractile left ventricle, did not lead to an adequate perfusion pressure. An ECLS was inserted to increase cardiac output. By providing an additional systemic blood flow of approx. 2.4 l/min we were able to thoroughly maintain adequate perfusion conditions in presence of the long half-life time of amlodipine. Fortunately, treatment with positive inotropic and vasoactive drugs could be reduced over time and the ECLS could be removed on day 5. After 10 days of treatment on the ICU, the patient was successfully transferred without any organ dysfunction to a psychiatric clinic. © 2021 DIOmed Verlags GmbH. All rights reserved. Language: de |
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Keywords |
adult; Intoxication; human; male; case report; suicide attempt; clinical article; drug intoxication; intensive care unit; noradrenalin; mental hospital; dobutamine; swallowing; Article; Shock; heart left ventricle; amlodipine; Extracorporeal life support; ramipril; half life time; heart output; extracorporeal oxygenation; systemic circulation; vasopressin derivative; systemic vascular resistance; perfusion pressure |