Is the Intra-Aortic Balloon Pump a Method of Brain Protection During Cardiogenic Shock After Drug Intoxication?

Janion, Marianna; Stępień, Aleksander; Sielski, Janusz; Gutkowski, Wojciech

doi:10.1016/j.jemermed.2007.10.037

Cited by 10 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One human case series of three patients 129 and one case report 130 suggested the use of extracorporeal albumin dialysis to improve hemodynamics without a clear impact on the serum CCB concentrations. Only human case reports were found for charcoal hemoperfusion; 131 continuous venovenous hemodiafiltration; 132–135 insertion of an intra-aortic balloon pump, 136 Impella device, 137 and methylene blue. 138–140 Animal studies showed conflicting results for the use of carnitine.…”

Section: Resultsmentioning

confidence: 99%

Treatment for calcium channel blocker poisoning: A systematic review

St‐Onge

Dubé

Gosselin

et al. 2014

Clinical Toxicology

159

135

View full text Add to dashboard Cite

ContextCalcium channel blocker poisoning is a common and sometimes life-threatening ingestion.ObjectiveTo evaluate the reported effects of treatments for calcium channel blocker poisoning. The primary outcomes of interest were mortality and hemodynamic parameters. The secondary outcomes included length of stay in hospital, length of stay in intensive care unit, duration of vasopressor use, functional outcomes, and serum calcium channel blocker concentrations.MethodsMedline/Ovid, PubMed, EMBASE, Cochrane Library, TOXLINE, International pharmaceutical abstracts, Google Scholar, and the gray literature up to December 31, 2013 were searched without time restriction to identify all types of studies that examined effects of various treatments for calcium channel blocker poisoning for the outcomes of interest. The search strategy included the following Keywords: [calcium channel blockers OR calcium channel antagonist OR calcium channel blocking agent OR (amlodipine or bencyclane or bepridil or cinnarizine or felodipine or fendiline or flunarizine or gallopamil or isradipine or lidoflazine or mibefradil or nicardipine or nifedipine or nimodipine or nisoldipine or nitrendipine or prenylamine or verapamil or diltiazem)] AND [overdose OR medication errors OR poisoning OR intoxication OR toxicity OR adverse effect]. Two reviewers independently selected studies and a group of reviewers abstracted all relevant data using a pilot-tested form. A second group analyzed the risk of bias and overall quality using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist and the Thomas tool for observational studies, the Institute of Health Economics tool for Quality of Case Series, the ARRIVE (Animal Research: Reporting In Vivo Experiments) guidelines, and the modified NRCNA (National Research Council for the National Academies) list for animal studies. Qualitative synthesis was used to summarize the evidence. Of 15,577 citations identified in the initial search, 216 were selected for analysis, including 117 case reports. The kappa on the quality analysis tools was greater than 0.80 for all study types.ResultsThe only observational study in humans examined high-dose insulin and extracorporeal life support. The risk of bias across studies was high for all interventions and moderate to high for extracorporeal life support. High-dose insulin. High-dose insulin (bolus of 1 unit/kg followed by an infusion of 0.5–2.0 units/kg/h) was associated with improved hemodynamic parameters and lower mortality, at the risks of hypoglycemia and hypokalemia (low quality of evidence). Extracorporeal life support. Extracorporeal life support was associated with improved survival in patients with severe shock or cardiac arrest at the cost of limb ischemia, thrombosis, and bleeding (low quality of evidence). Calcium, dopamine, and norepinephrine. These agents improved hemodynamic parameters and survival without documented severe side effects (very low quality of evidence). 4-Aminopyridine. Use of 4-aminopyridine was assoc...

show abstract

Section: Resultsmentioning

confidence: 99%

Treatment for calcium channel blocker poisoning: A systematic review

St‐Onge

Dubé

Gosselin

et al. 2014

Clinical Toxicology

159

135

View full text Add to dashboard Cite

show abstract

“…Janion et al (32) reported successful treatment of combined massive drug intoxication using mechanical ventilation and IABP, concluding that combined mechanical and pharmacological treatment may even prevent multiorgan insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning

Mehrpour

Amouzeshi

Dadpour

et al. 2014

Archives of Industrial Hygiene and Toxicology

View full text Add to dashboard Cite

Aluminium phosphide (AlP) is a highly toxic pesticide that inhibits cytochrome oxidase c and causes oxidative stress. Death results from refractory cardiogenic shock due to myocardial dysfunction. There is very little information regarding extracorporeal life support in severe AlP poisoning. Although several therapies are available, none are curative. We report on the use of an intra-aortic balloon pump (IABP) in a 24-year-old woman brought to our hospital after an intentional ingestion of a tablet of AlP (3 g), which caused refractory AlP-induced cardiogenic shock and acute respiratory distress syndrome (ARDS). The patient underwent gastric lavage with potassium permanganate, received sodium bicarbonate intravenously, and was admitted to the intensive care unit. Echocardiography at 36 h post ingestion showed a left ventricular ejection fraction (LVEF) of <20 %. An IABP was inserted and the patient's vital signs stabilised. After eight days, the IABP was removed and on day 20, the patient's LVEF increased to 50 %. IABP was successfully used and may improve future prognoses for severely poisoned AlP patients with refractory cardiogenic shock. We encourage clinical toxicologists to examine this new treatment.

show abstract

“…Calcium channel blocker overdoses can cause hypotension, non‐cardiogenic pulmonary oedema, sinus arrest, atrioventricular block, a reduction in cardiac output and hyperglycaemia . To restore blood pressure, inotropic agents, pacemaker devices or intra‐aortic balloon pumps may be used . Case studies emphasize the advantages of ECMO and heart–lung machines .…”

mentioning

confidence: 99%

Evaluation of the Effectiveness of Sugammadex for Verapamil Intoxication

Özbılgın

Özbilgin

Kucukoztas

et al. 2013

Basic Clin Pharma Tox

View full text Add to dashboard Cite

Previous studies have shown that medications from the cyclodextrin family bind to verapamil. The aim of our study was to determine whether sugammadex could bind to verapamil and prevent the cardiovascular toxicity of that drug. Twenty-eight sedated Wistar rats were infused with verapamil at 37.5 mg/kg/h. Five minutes after the start of infusion, the animals were treated with a bolus of either 16 mg/kg, 100 mg/kg or 1000 mg/kg sugammadex. The control group was treated with an infusion without sugammadex. The heart rate and respiratory rate were monitored, and an electrocardiogram was recorded. The primary end-point was the time to asystole. The verapamil infusion continued until the animals arrested. The asystole time for the S16 group was significantly longer compared to those for the control and S1000 groups (p < 0.05). The asystole time for the S1000 group was significantly shorter than those for all of the other groups (p < 0.05). Reflecting these data, there was a near doubling of the mean lethal dose of verapamil from 13.57 mg/kg (S.D. AE8.1) in the saline-treated rats to 22.42 mg/kg (S.D. AE9.9) in the sugammadex 16 group (p < 0.05). However, for the sugammadex 1000 group, the mean lethal dose was found to be 6.28 AE 1.11 mg/kg. This dose is significantly lower than those for all of the other groups (p < 0.05). We found that treatment with 16 mg/kg sugammadex delayed verapamil cardiotoxicity in rats. However, 1000 mg/kg sugammadex accelerated verapamil cardiotoxicity in rats. Further studies must be conducted to investigate the interaction between verapamil and sugammadex.

show abstract

Is the Intra-Aortic Balloon Pump a Method of Brain Protection During Cardiogenic Shock After Drug Intoxication?

Cited by 10 publications

References 16 publications

Treatment for calcium channel blocker poisoning: A systematic review

Treatment for calcium channel blocker poisoning: A systematic review

Successful treatment of cardiogenic shock with an intraaortic balloon pump following aluminium phosphide poisoning

Evaluation of the Effectiveness of Sugammadex for Verapamil Intoxication

Contact Info

Product

Resources

About