Citation

Felix A, Campbell D, Neavyn M, Hackett P. J. Emerg. Crit. Care Med. 2022; 6.

Copyright

(Copyright © 2022)

DOI

10.21037/jeccm-22-2

PMID

unavailable

Abstract

BACKGROUND: Antidepressant medications such as venlafaxine (VEN), a selective serotonin and norepinephrine reuptake inhibitor, are a leading cause of annual suicide attempts. Morbidity and mortality is often related to cardiovascular toxicity. Management has previously focused on supportive care. We describe a case of VEN overdose leading to cardiogenic collapse, and requiring the use of rescue extracorporeal membrane oxygenation (ECMO) with complete return to cardiac and neurological function. This is a novel use of ECMO, and one of the first described in the United States. Case Description: Our case illustrates the clinical course of a young female in cardiogenic shock after an ingestion of VEN. We review the suspected etiologies of cardiogenic collapse in VEN ingestion, which include excessive adrenergic stimulation and myocardial stunning. We trend VEN concentrations over time, demonstrating ingestion was likely higher than previously reported and note that this is the highest ratio of VEN to its primary metabolite, O-desmethylvenlafaxine (ODV), reported in the literature.

CONCLUSIONS: The patient in our case makes a full cardiogenic and neurological recovery. Our case demonstrates that ECMO is a viable rescue therapy in VEN overdose. © 2022 Laparoscopic Surgery.All right reserved.

Language: en

Keywords

case report; antidepressants; Extracorporeal cardiopulmonary resuscitation; extracorporeal membrane oxygenation (ECMO); venlafaxine (VEN)