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Extracorporeal life support in a case of acute carbamazepine poisoning with life-threatening refractory myocardial failure

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Abstract

Objective

To report the efficacy of extracorporeal life support (ECLS) in acute carbamazepine poisoning with sustained refractory myocardial failure and a high degree of conductance disturbances.

Design and setting

Case report from the toxicological and medical intensive care unit in a university hospital.

Patient

A 26-year-old man with severe myocardial failure unresponsive to 1.7 μg kg−1 min−1 epinephrine and 1.9 μg kg−1 min−1 norepinephrine (SvO2, 17.8% and cardiac index, 0.8 l min−1 m−2) following a suicidal ingestion of 32 g slow-release carbamazepine.

Interventions

ECLS (Jostra-Maquet centrifugal pump (Rotaflow) connected to a hollow-fiber membrane oxygenator).

Measurements and results

ECLS device allowed inotropic drug weaning while maintaining end-organ function and supported the patient until myocardial recovery. The plasma carbamazepine level was 224 μmol/l on admission and peaked at 338 μmol/l 101 h after admission with a prolonged gastrointestinal absorption phase despite multiple doses of activated charcoal. The patient survived and was successfully explanted on day 6. An extensive and regressive thrombosis of the inferior vena cava was noted. Cardiac function totally recovered and at 2-year follow-up. There were no significant sequelae.

Conclusions

We report a case of life-threatening myocardial failure with conductance disturbances secondary to an acute carbamazepine poisoning, demonstrating the efficacy of ECLS to assist recovery.

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Acknowledgements

The authors thank Dr. Rebeca Gracia, PharmD, DABAT, from the North Texas Poison Center, Dallas, Tex., USA, for her helpful review of this manuscript.

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Authors and Affiliations

  1. AP-HP, Hôpital Lariboisière, Réanimation Médicale et Toxicologique, INSERM U705, CNRS, UMR 7157, Université Paris VII, 2 Rue Ambroise Paré, 75010, Paris, France

    Bruno Mégarbane, Nicolas Deye, Gilles Guerrier, Dabor Résière, Vanessa Bloch & Frédéric J. Baud

  2. Chirurgie Cardiovasculaire et Thoracique, AP-HP, Hôpital Pitié Salpétrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France

    Pascal Leprince

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  1. Bruno Mégarbane
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  2. Pascal Leprince
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  3. Nicolas Deye
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  4. Gilles Guerrier
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  5. Dabor Résière
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  6. Vanessa Bloch
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  7. Frédéric J. Baud
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Correspondence to Frédéric J. Baud.

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Mégarbane, B., Leprince, P., Deye, N. et al. Extracorporeal life support in a case of acute carbamazepine poisoning with life-threatening refractory myocardial failure. Intensive Care Med 32, 1409–1413 (2006). https://doi.org/10.1007/s00134-006-0257-8

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  • DOI: https://doi.org/10.1007/s00134-006-0257-8

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