Case Reports
Successful Treatment of Metoprolol-Induced Cardiac Arrest With High-Dose Insulin, Lipid Emulsion, and ECMO,☆☆,,★★,☆☆☆

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Abstract

β-Adrenergic antagonist toxicity causes cardiovascular collapse often refractory to standard therapy. Alternative therapies include high-dose insulin, lipid emulsion, and venoarterial extracorporeal membrane oxygenation (VA-ECMO). A 47-year-old man ingested 10 g of metoprolol tartrate in a suicide attempt. Upon emergency department presentation, he was comatose, bradycardic, and hypotensive. Glucagon (14 mg IV) and vasopressor/inotropic support (epinephrine 0.1 μg/[kg min], dobutamine 10 μg/[kg

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  • Cited by (23)

    • Local Anesthetic Systemic Toxicity Induced Cardiac Arrest After Topicalization for Transesophageal Echocardiography and Subsequent Treatment With Extracorporeal Cardiopulmonary Resuscitation

      2019, Journal of Cardiothoracic and Vascular Anesthesia
      Citation Excerpt :

      In patients with cardiopulmonary instability despite intravenous lipids, consideration should be given to alerting the nearest facility capable of ECLS. The use of ECLS—most commonly venoarterial ECMO—for cardiopulmonary collapse due to medication overdose has been described well,11–13 and appears to be cost effective,14 though large series are limited.15 In a review of ED ECMO for cardiopulmonary collapse due to cardio toxic drugs by Johnson et al., the most common medications were calcium channel blockers and antiarrhythmics.16

    • Extracorporeal life support in cardiotoxicant poisoning—A narrative review

      2023, Basic and Clinical Pharmacology and Toxicology
    • Progress in lipid emulsions as antidotes to reverse drug poisoning

      2022, Journal of China Pharmaceutical University
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    The care provided in case report described occurred at UPMC Presbyterian, Pittsburgh, PA.

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    Poster presentation describing this case was previously presented at 43rd Society of Critical Care Medicine Annual Congress, San Francisco, CA, January 9-13, 2014.

    3600 Forbes Ave, Suite 400A, Iroquois Building, Pittsburgh, PA, for reprints; no reprints to be ordered.

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    Financial support: University of Pittsburgh, Department of Emergency Medicine.

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    Conflicts of interest: none.

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