Biventricular assist device for scombroid poisoning with refractory myocardial dysfunction: A bridge to recovery

We report the usefulness of biventricular mechanical circulatory support in a 36-yr-old woman with refractory myocardial dysfunction resulting from scombroid poisoning. Design: Case report. Setting: Medical and surgical university care units. Patient A previously healthy 36-yr-old woman with severe myocardial dysfunction unresponsive to epinephrine (1.3 mug/kg/min) and dobutamine (18 mug/kg/min) after the ingestion of cooked fresh tuna. Intervention: Implantation at day 3 of a biventricular assist device consisting of two paracorporeal pneumatic pumps set at 70 beats/min to reach an output of 5.6 L/min during 8 days. Main Results: The biventricular mechanical circulatory assist device allowed weaning of the inotropic drugs, maintenance of end-organ function, and support of the patient until myocardial recovery. The patient was successfully explanted 11 days after ingestion. Cardiac function had totally recovered, but a stroke was noted. At 3-yrs follow-up, there was no cardiac or neurologic sequela. Conclusions: This report describes severe myocardial dysfunction secondary to scombroid poisoning and demonstrates the usefulness of a mechanical circulatory assist device as a bridge to recovery.