Behringer W, Sterz F, Domanovits H, Schoerkhuber W, Holzer M, Foedinger M, Laggner A N
Department of Emergency Medicine, University of Vienna, Medical School, Austria.
Resuscitation. 1998 Apr;37(1):47-50. doi: 10.1016/s0300-9572(98)00025-2.
A 79-year 65 kg male called the ambulance service 4 h after ingestion of 100 tablets of digoxin 0.1 mg complaining of nausea and vomiting. The ECG showed an idioventricular escape rhythm with a heart rate of 30/min. After 0.5 mg atropine, heart rate increased to 80/min. Soon after admission to the emergency department, the patient developed electromechanical dissociation. Due to persistent cardiac arrest, percutaneous cardiopulmonary bypass was started, and the ECG rhythm changed to ventricular fibrillation. Several attempts to terminate ventricular fibrillation by electrical defibrillation failed. Fifty-eight minutes after cardiac arrest, antidigoxin-Fab was administered and 1 h 25 min after cardiac arrest, ventricular fibrillation was terminated by the tenth electrical defibrillation attempt. Initially, the patient's overall status improved over the next 2 days, but then he developed a severe adult respiratory distress syndrome and died of unresponsive septic shock 12 days after ingestion of digoxin. This case demonstrates that percutaneous cardiopulmonary bypass may provide support in patients with cardiac arrest due to massive digoxin overdose. This temporary support can maintain adequate tissue perfusion during the time required for drug neutralization in order to achieve successful defibrillation. Percutaneous cardiopulmonary bypass should be considered in patients with severe, but temporary cardiac dysfunction due to a life-threatening drug overdose.
一名79岁、体重65公斤的男性在服用100片0.1毫克地高辛4小时后呼叫了急救服务，主诉恶心和呕吐。心电图显示心室自主逸搏心律，心率为30次/分钟。给予0.5毫克阿托品后，心率增至80次/分钟。患者被送往急诊科后不久，出现了电机械分离。由于持续性心脏骤停，开始进行经皮心肺旁路支持，心电图节律变为心室颤动。多次尝试通过电击除颤终止心室颤动均失败。心脏骤停58分钟后，给予抗地高辛Fab片段，心脏骤停1小时25分钟后，第十次电击除颤尝试成功终止了心室颤动。最初，患者的整体状况在接下来的2天有所改善，但随后他出现了严重的成人呼吸窘迫综合征，并在摄入地高辛12天后死于难治性感染性休克。该病例表明，经皮心肺旁路可为因大量地高辛过量导致心脏骤停的患者提供支持。这种临时支持可在药物中和所需时间内维持足够的组织灌注，以实现成功除颤。对于因危及生命的药物过量导致严重但暂时性功能障碍的患者，应考虑采用经皮心肺旁路支持。
