Extracorporeal life support: The final ‘antidote’ for massive propranolol overdose
Journal
Hong Kong Journal of Emergency Medicine
Journal Volume
26
Journal Issue
2
Pages
118-123
Date Issued
2019
Author(s)
Abstract
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. ? The Author(s) 2018.
Subjects
Beta-blocker overdose; extracorporeal life support; plasma exchange; propranolol
SDGs
Other Subjects
antidote; atropine; bicarbonate; dopamine; epinephrine; fresh frozen plasma; glucagon; insulin; lactic acid; lipovenoes; propranolol; adult; Article; atrial fibrillation; blood gas analysis; blood pressure; bradycardia; breathing rate; case report; clinical article; coronary care unit; drug overdose; echocardiography; electric activity; electrocardiogram; electrocardiography; female; general condition improvement; heart ejection fraction; heart rate; hemodynamics; human; hypotension; long term care; middle aged; physical examination; plasma exchange; plasma volume; pulse rate; QRS interval; resuscitation; return of spontaneous circulation; suicide attempt; systolic blood pressure
Publisher
SAGE Publications Ltd
Type
journal article