PMID- 26299692
OWN - NLM
STAT- MEDLINE
DCOM- 20151221
LR  - 20150924
IS  - 1532-8171 (Electronic)
IS  - 0735-6757 (Linking)
VI  - 33
IP  - 10
DP  - 2015 Oct
TI  - Successful treatment of flecainide-induced cardiac arrest with extracorporeal 
      membrane oxygenation in the ED.
PG  - 1542.e1-2
LID - S0735-6757(15)00610-5 [pii]
LID - 10.1016/j.ajem.2015.07.054 [doi]
AB  - Flecainide is a class Ic antidysrhythmic agent used to prevent and treat 
      tachydysrhythmias. Flecainide toxicity primarily causes cardiovascular and 
      neurologic effects through sodium-channel blockade. There is scant evidence to 
      support specific management, and recommended therapies have been extrapolated 
      from management of other sodium-channel blocking drugs. Traditionally, these 
      therapies have consisted of intravenous fluids, sodium bicarbonate, vasopressors, 
      and cardiac pacing. Novel therapies include intravenous fat emulsion and 
      venoarterial extracorporeal membrane oxygenation (VA-ECMO). A 24-year-old woman 
      ingested her husband's flecainide and presented to the emergency department (ED) 
      in profound shock with a wide complex bradydysrhythmia. Despite aggressive 
      medical therapy including sodium bicarbonate, vasopressors, cardiac pacing, and 
      intravenous fat emulsion, her condition deteriorated and she developed pulseless 
      electrical activity (PEA) cardiac arrest refractory to standard resuscitation. 
      Venoarterial extracorporeal membrane oxygenation was initiated in the ED, and the 
      patient remained comatose and critically ill in the intensive care unit. Her 
      hemodynamics and mental status recovered, but she had compartment syndrome in her 
      left leg requiring fasciotomy. She was discontinued from VA-ECMO on hospital day 
      5, extubated on hospital day 6, and discharged home with excellent neurologic 
      recovery on hospital day 19. Intravenous fat emulsion is thought to sequester the 
      offending agent in a plasma lipid "sink," alter ion channel permeability, and/or 
      modify fatty acid utilization by the myocardium. The quality of evidence for 
      intravenous fat emulsion is generally low. Venoarterial extracorporeal membrane 
      oxygenation was used in this patient to restore organ perfusion and allow 
      intrinsic drug metabolism and elimination. Venoarterial extracorporeal membrane 
      oxygenation should be strongly considered for refractory shock and/or cardiac 
      arrest secondary to flecainide toxicity.
FAU - Reynolds, Joshua C
AU  - Reynolds JC
AD  - Department of Emergency Medicine, Michigan State University College of Human 
      Medicine, Grand Rapids, MI, USA; Spectrum Health Hospitals, Grand Rapids, MI, 
      USA.
FAU - Judge, Bryan S
AU  - Judge BS
AD  - Department of Emergency Medicine, Michigan State University College of Human 
      Medicine, Grand Rapids, MI, USA; Spectrum Health Hospitals, Grand Rapids, MI, 
      USA; Grand Rapids Medical Education Partners Emergency Medicine Residency, Grand 
      Rapids, MI, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20150729
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
RN  - 0 (Anti-Arrhythmia Agents)
RN  - K94FTS1806 (Flecainide)
SB  - IM
MH  - Anti-Arrhythmia Agents/*poisoning
MH  - Emergency Service, Hospital
MH  - *Extracorporeal Membrane Oxygenation
MH  - Female
MH  - Flecainide/*poisoning
MH  - Heart Arrest/*chemically induced/*therapy
MH  - Humans
MH  - Young Adult
EDAT- 2015/08/25 06:00
MHDA- 2015/12/22 06:00
CRDT- 2015/08/25 06:00
PHST- 2015/07/09 00:00 [received]
PHST- 2015/07/24 00:00 [accepted]
PHST- 2015/08/25 06:00 [entrez]
PHST- 2015/08/25 06:00 [pubmed]
PHST- 2015/12/22 06:00 [medline]
AID - S0735-6757(15)00610-5 [pii]
AID - 10.1016/j.ajem.2015.07.054 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2015 Oct;33(10):1542.e1-2. doi: 10.1016/j.ajem.2015.07.054. Epub 
      2015 Jul 29.