PMID- 33655968
OWN - NLM
STAT- MEDLINE
DCOM- 20210309
LR  - 20220421
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 100
IP  - 9
DP  - 2021 Mar 5
TI  - Veno-arterial extracorporeal membrane oxygenation and targeted temperature 
      management in tricyclic antidepressant-induced cardiac arrest: A case report and 
      literature review.
PG  - e24980
LID - 10.1097/MD.0000000000024980 [doi]
LID - e24980
AB  - RATIONALE: Cardiotoxicity is a common cause of death in tricyclic antidepressant 
      (TCA) intoxication. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) 
      is effective in critically ill poisoned patients who do not respond to 
      conventional therapies, and targeted temperature management (TTM) is associated 
      with improved neurological outcomes and mortality in comatose out-of-hospital 
      cardiac arrest survivors. However, few reports have documented cases of TCA 
      intoxication that required intensive care, including VA-ECMO or TTM. PATIENT 
      CONCERNS: A 19-year-old Japanese man with a history of depression was brought to 
      our hospital because he was in a comatose state with a generalized seizure. 
      Before admission, he had taken an unknown amount of amitriptyline. DIAGNOSIS: 
      After intubation, the electrocardiogram (ECG) displayed a wide QRS complex 
      tachycardia, and the patient suffered from cardiovascular instability despite 
      intravenous bolus of sodium bicarbonate. At 200 minutes after ingestion, he 
      experienced a TCA-induced cardiac arrest. INTERVENTIONS: We initiated VA-ECMO 240 
      minutes after ingestion. The hemodynamic status stabilized, and the ECG 
      abnormality improved gradually. In addition, we initiated targeted temperature 
      management (TTM) with a target temperature of 34 degrees C. OUTCOMES: Twenty seven hours 
      after starting the pump, the patient was weaned off the VA-ECMO. After completing 
      the TTM, his mental status improved, and he was extubated on day 5. He was 
      discharged on day 15 without neurological impairment, and the post-discharge 
      course was uneventful. LESSONS: First, VA-ECMO is effective in patients with 
      TCA-induced cardiac arrest. Second, routine ECG screening during VA-ECMO support 
      is useful for assessing the timing to wean off the VA-ECMO, as well as the degree 
      of cardiotoxicity. Third, TTM is safe in comatose survivors of cardiac arrest 
      caused by severe TCA intoxication.
CI  - Copyright (c) 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
FAU - Ikejiri, Kaoru
AU  - Ikejiri K
AUID- ORCID: 0000-0002-0801-9457
AD  - Emergency and Critical Care Center, Mie University Hospital, 2-174 Edobashi, Tsu 
      city, Mie 514-8507, Japan.
FAU - Akama, Yuichi
AU  - Akama Y
FAU - Ieki, Yohei
AU  - Ieki Y
FAU - Kawamoto, Eiji
AU  - Kawamoto E
FAU - Suzuki, Kei
AU  - Suzuki K
FAU - Yokoyama, Kazuto
AU  - Yokoyama K
FAU - Ishikura, Ken
AU  - Ishikura K
FAU - Imai, Hiroshi
AU  - Imai H
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Antidepressive Agents, Tricyclic)
SB  - IM
MH  - Antidepressive Agents, Tricyclic/*adverse effects
MH  - Electrocardiography
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Heart Arrest/*chemically induced/therapy
MH  - Humans
MH  - Hypothermia, Induced/*methods
MH  - Male
MH  - Young Adult
PMC - PMC7939188
COIS- The authors have no funding and conflicts of interest to disclose.
EDAT- 2021/03/04 06:00
MHDA- 2021/03/10 06:00
PMCR- 2021/03/05
CRDT- 2021/03/03 08:53
PHST- 2020/12/09 00:00 [received]
PHST- 2021/02/11 00:00 [accepted]
PHST- 2021/03/03 08:53 [entrez]
PHST- 2021/03/04 06:00 [pubmed]
PHST- 2021/03/10 06:00 [medline]
PHST- 2021/03/05 00:00 [pmc-release]
AID - 00005792-202103050-00065 [pii]
AID - MD-D-20-12167 [pii]
AID - 10.1097/MD.0000000000024980 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2021 Mar 5;100(9):e24980. doi: 10.1097/MD.0000000000024980.