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Extracorporeal circulatory support in near-fatal flecainide overdose
M A Corkeron1, P V van Heerden, S M Newman
1Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
Anaesthesia and Intensive Care
|September 2, 1999
Summary
A massive flecainide overdose in a young woman was successfully treated with cardiopulmonary bypass (CPB). Despite severe symptoms, she recovered fully without neurological deficit, highlighting CPB as a life-saving intervention for severe antiarrhythmic drug toxicity.
Area of Science:
- Cardiology
- Toxicology
- Critical Care Medicine
Background:
- Flecainide, a Class 1c antiarrhythmic, carries a high mortality risk with significant overdose.
- Intentional self-poisoning with antiarrhythmic drugs presents a critical management challenge.
Observation:
- A 20-year-old female ingested approximately 4 grams of flecainide, leading to refractory circulatory failure.
- Initial treatments including pacing, inotropes, and sodium bicarbonate were ineffective.
Findings:
- Cardiopulmonary bypass (CPB) was initiated and successfully managed the circulatory collapse.
- The patient experienced coagulopathy, intravascular hemolysis, and ischemic renal dysfunction requiring hemodiafiltration during CPB.
- Full recovery occurred over 24 hours, with successful weaning from CPB 30 hours after initiation, and no neurological deficit.
Implications:
- This case demonstrates the efficacy of extracorporeal circulatory support in managing life-threatening flecainide overdose.
- Successful recovery without neurological sequelae underscores the potential of advanced life support in severe drug toxicity.
- Highlights the critical role of CPB in managing refractory cardiogenic shock due to antiarrhythmic overdose.