Journal
INDIAN JOURNAL OF CRITICAL CARE MEDICINE
Volume 22, Issue 2, Pages 111-115Publisher
MEDKNOW PUBLICATIONS & MEDIA PVT LTD
DOI: 10.4103/ijccm.IJCCM_417_17
Keywords
Beta blockers; calcium channel blockers; circulatory assist device; drug overdose; extracorporeal membrane oxygenation
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Overdose of cardiovascular medications such as beta blockers and calcium channel blockers cause impaired cardiac contractility, vasoplegia, and/or rhythm disturbances. In addition to conventional management of limiting absorption, increasing elimination and hemodynamic support intravenous (IV) calcium infusion, hyperinsulinemia-euglycemia therapy, glucagon infusion, and IV lipid emulsion have been tried. Extracorporeal circulatory assist device support has been reported as a rescue therapy in overdose refractory to maximal medical therapy. We report three patients with cardiovascular medication overdose presenting with profound cardiovascular instability refractory to medical therapy. Venoarterial extracorporeal membrane oxygenation support (VA ECMO) was initiated to provide hemodynamic support. Despite the occurrence of device-associated complications, the outcome was good and all patients survived. VA ECMO may be considered in patients with severe refractory shock due to cardiotoxic medication overdose.
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