Successful treatment of propafenone-induced cardiac arrest by calcium gluconate

A case of lethal suicidal intoxication with propafenone and diazepam

Diazepam poisoning is a common emergency situation, but propafenone poisoning is relatively rare. We reported a case of propafenone poisoning combined with diazepam. An 18-year-old female patient was admitted to our hospital with an overdose of oral propafenone and diazepam. The patient was treated with medication that proved to be useful, but the sinus rhythm could not be recovered, and cardiac arrest occurred. A bipolar temporary pacemaker and extracorporeal membrane oxygenation (ECMO) were installed. However, even with multiple electrode positions, effective capture could not be achieved. The patient eventually died. We should be alert to the possibility of co-poisoning.

Antiarrhythmic Drug Dosing in Children-Review of the Literature

Antiarrhythmic drugs represent a mainstay of pediatric arrhythmia treatment. However, official guidelines and consensus documents on this topic remain scarce. There are rather uniform recommendations for some medications (including adenosine, amiodarone, and esmolol), while there are only very broad dosage recommendations for others (such as sotalol or digoxin). To prevent potential uncertainties and even mistakes with regard to dosing, we summarized the published dosage recommendations for antiarrhythmic drugs in children. Because of the wide variations in availability, regulatory approval, and experience, we encourage centers to develop their own specific protocols for pediatric antiarrhythmic drug therapy.

Electrocardiostimulation in acute poisoning with antiarrhythmic drugs in children (clinical case)

Severe poisoning with cardiotropic drugs in children,  accompanied  by pronounced rhythm disorders  and low cardiac output syndrome,  is quite rare, but sometimes they can end fatally.

The objective was to demonstrate the successful use of electrocardiostimulation in acute propafenone  poisoning in a child of three years old.

Materials and Methods. A retrospective analysis of the features of the course of severe propafenone poisoning in a three-year-old child who required pacing was carried out. Special attention was paid to the analysis of rhythm disorders  that  led to cardiac arrest  by the type of electrical  activity without a pulse, high efficiency of timely electrocardiostimulation in order to relieve bradyarrhythmia. Against the background of the therapy,  a stable recovery of the correct  sinus rhythm was achieved six hours after the connection of a temporary electrocardiostimulator.

Conclusion. The presence  of persistent bradyarrhythmia-type rhythm disorders  in acute  poisoning with antiarrhythmic drugs in children  is an indication for the emergency use of electrocardiostimulation.

Pediatric extracorporeal cardiopulmonary resuscitation settled in an emergency department for a propafenone intentional intoxication

The use of drugs in suicide attempts is becoming more and more frequent among adolescents. Intentional intoxication with propafenone is very rare and mainly reported in adults associated with other drugs. The therapeutic approach is symptomatic, since there is no specific antidote for propafenone. We present a pediatric case of intentional ingestion of 1.8 g of propafenone that caused refractory cardiogenic shock. The patient was successfully rescued with extracorporeal cardiopulmonary resuscitation in the emergency department of a secondary level peripheral hospital.

Full recovery after prolonged resuscitation from cardiac arrest due to propafenone intoxication: A case report

RATIONALE

The prognosis of cardiac arrest (CA) induced by propafenone intoxication was thought to be very poor. The maximal duration of cardiopulmonary resuscitation (CPR) for propafenone induced CA is unknown.

PATIENT CONCERNS

We describe a case that was successfully resuscitated after prolonged CPR (totaling 340 minutes during one hospital visit) for propafenone intoxication without subsequent neurological sequela.

DIAGNOSES

A previously healthy 36-year-old female who developed multiple and prolonged CAs after consuming 98 tablets of 50mg propafenone. The CPR duration of this case, to the best of our knowledge, is the longest of all existing propafenone-induced CPR events to still have full recovery. We also analyse the contributing factors to this successful CPR.

INTERVENTIONS

Sodium bicarbonate, inotropic drugs and pacemaker application did not prevent the occurrence of CA. A full recovery was eventually achieved after prolonged CPR with a mechanical CPR device, blood purification and other aggressive supportive treatments.

OUTCOMES

Full recovery without neurological sequela.

LESSONS

Prolonged CPR including the application of mechanical CPR devices should be considered in propafenone-related CA, especially in young patients without significant comorbidities and delayed resuscitation.