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Epinephrine-induced electrical storm after aortic surgery.

Adam L Weinstein¹, Neal S Gerstein², Josh I Santos²

¹Department of Anesthesiology, UW School of Medicine and Public Health, Madison, WI, USA.

Saudi Journal of Anaesthesia

|October 2, 2019

Summary

High-dose epinephrine, used for hemodynamic support during cardiovascular surgery, can paradoxically trigger electrical storm (ES). Stopping the infusion rapidly resolved ES in a patient with an aortic dissection, highlighting a critical clinical consideration.

Keywords:

Electric storm ventricular fibrillation ventricular tachycardia

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Area of Science:

Cardiology
Critical Care Medicine
Pharmacology

Background:

Electrical storm (ES) is a life-threatening condition characterized by recurrent ventricular arrhythmias.
Excess catecholamine effects are a known trigger for ES.
The use of exogenous catecholamines for hemodynamic support can potentially exacerbate underlying arrhythmias.

Observation:

A 63-year-old male developed ES after repair of an ascending aortic dissection, requiring over 40 defibrillatory shocks.
The ES occurred following cardiopulmonary bypass separation supported by high-dose epinephrine infusion.
Discontinuation of the epinephrine infusion led to the spontaneous termination of ES within 5 minutes.

Findings:

This case report describes the first instance of ES precipitated by epinephrine during cardiovascular surgery.
High-dose epinephrine, intended for hemodynamic support, demonstrated a paradoxical effect by inducing or worsening ventricular arrhythmias.
The rapid resolution of ES upon cessation of epinephrine suggests a direct causal link.

Implications:

Clinicians must be aware of the potential for exogenous catecholamines, specifically epinephrine, to induce ES in surgical patients.
Identifying and removing exacerbating factors, such as excess catecholamines, is crucial in the initial management of ES.
This finding necessitates careful consideration of epinephrine dosage and duration in patients at risk for arrhythmias during cardiovascular procedures.