Successful rescue for anaphylactic shock due to sugammadex using extracorporeal cardiopulmonary resuscitation

IntroductionSugammadex (Bridion®, MSD, Seoul, Republic of Korea) is widely used for neuromuscular blockade reversal at the end of general anesthesia. We report a rare case of refractory cardiac arrest secondary to sugammadex-induced anaphylaxis, successfully managed with extracorporeal cardiopulmonary resuscitation.Case presentationA 44-year-old man with no history of cardiovascular disease underwent robotic-assisted partial nephrectomy for a renal mass; 3 min after sugammadex intravenous administration, the patient developed ventricular fibrillation. Advanced cardiac life support was initiated, and the extracorporeal membrane oxygenation (ECMO) team was activated. Venoarterial ECMO was initiated 37 min after cardiac arrest onset. The patient was successfully weaned off the ECMO the following day. During admission, intradermal and ergonovine provocation tests confirmed a hypersensitivity reaction to sugammadex and coronary artery spasm, respectively. The patient was discharged on postoperative day 71, without any neurological sequelae.ConclusionThis successful extracorporeal cardiopulmonary resuscitation (ECPR) in refractory perioperative cardiac arrest due to sugammadex-induced anaphylaxis, highlights that early ECMO team activation and rapid ECPR implementation may lead to favorable neurological recovery.