Open AccessExtracorporeal life support: The final ‘antidote’ for massive propranolol overdose
Author(s) -
Chen LiangWen,
Mao Desmond Renhao,
Chen YihSharng
Publication year - 2019
Publication title -
hong kong journal of emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.145
H-Index - 12
eISSN - 2309-5407
pISSN - 1024-9079
DOI - 10.1177/1024907918762868
Subject(s) - medicine , extracorporeal , life support , propranolol , advanced cardiac life support , anesthesia , inotrope , advanced life support , intensive care medicine , extracorporeal circulation , resuscitation , cardiopulmonary resuscitation , surgery
Massive propranolol overdose may result in severe cardiotoxicity. A 48‐year‐old female had consumed more than 5000 mg of propranolol. Despite high‐dose insulin, intravenous sodium bicarbonate, glucagon and inotropic support, she became hypotensive and subsequently arrested. Following cardiopulmonary resuscitation, she had a return of spontaneous circulation but continued to experience refractory hypotension. Resuscitation continued with veno‐arterial extracorporeal life support. Therapeutic plasma exchange was initiated to shorten time on extracorporeal life support. Extracorporeal life support was weaned off within 67 h, and she survived without neurological deficits. This records the largest propranolol overdose in recent years. When traditional antidotes are insufficient to prevent collapse, extracorporeal life support is a salvage therapy to maintain perfusion and reduce vasopressor requirements. As drug clearance is significantly prolonged, therapeutic plasma exchange can enhance removal of propranolol and reduce the time to extracorporeal life support removal. With increasing expertise and availability, extracorporeal life support should be considered early in patients who have overdosed with significant cardiotoxicity.