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Combination of veno-arterial extracorporeal membrane oxygenation and hypothermia for out-of-hospital cardiac arrest due to Taxus intoxication

Published online by Cambridge University Press:  04 March 2015

Aurélie Thooft ,
Ahmed Goubella ,
David Fagnoul ,
Fabio S. Taccone ,
Serge Brimioulle ,
Jean-Louis Vincent  and
Daniel De Backer
Aurélie Thooft
Affiliation:
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Ahmed Goubella
Affiliation:
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
David Fagnoul
Affiliation:
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Fabio S. Taccone
Affiliation:
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Serge Brimioulle
Affiliation:
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Jean-Louis Vincent
Affiliation:
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Daniel De Backer*
Affiliation:
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
*
Correspondence to: Dr. Daniel De Backer, Department of Intensive Care, Erasme University Hospital, Route de Lennik, 808 – 1070 Brussels, Belgium, ddebacke@ulb.ac.be.

Abstract

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A young woman presented with cardiac arrest following ingestion of yew tree leaves of the Taxus baccata species. The toxin in yew tree leaves has negative inotropic and dromotropic effects. The patient had a cardiac rhythm that alternated between pulseless electrical activity with a prolonged QRS interval and ventricular fibrillation. When standard resuscitation therapy including digoxin immune Fab was ineffective, a combination of extracorporeal membrane oxygenation (ECMO) and hypothermia was initiated. The total duration of low flow/no flow was 82 minutes prior to the initiation of ECMO. After 36 hours of ECMO (including 12 hours of electrical asystole), the patient’s electrocardiogram had normalized and the left ventricular ejection fraction was 50%. At this time, dobutamine and the ECMO were stopped. The patient had a full neurologic recovery and was discharged from the intensive care unit after 5 days and from the hospital 1 week later.

Keywords

cardiac arrestextracorporeal membrane oxygenationintoxicationtherapeutic hypothermia
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 6 , November 2014 , pp. 504 - 507
Copyright
Copyright © Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1.Alloatti, G, Penna, C, Levi, RC, et al. Effects of yew alkaloids and related compounds on guinea-pig isolated perfused heart and papillary muscle. Life Sci 1996;58:845-54, doi:10.1016/0024-3205(96)00018-5.CrossRefGoogle ScholarPubMed
2.Tekol, Y, Kameyama, M. [Electrophysiology of the mechanisms of action of the yew toxin, taxine, on the heart]. Arzneimittelforschung 1987;37:428-31.Google Scholar
3.Wilson, CR, Sauer, J, Hooser, SB. Taxines: a review of the mechanism and toxicity of yew (Taxus spp.) alkaloids. Toxicon 2001;39:175-85, doi:10.1016/S0041-0101(00)00146-X.CrossRefGoogle ScholarPubMed
4.Hurt, S. Poisonous effects of the berries, or seeds, of the yew. Lancet 1836;27:394-5, doi:10.1016/S0140-6736(02)98995-6.CrossRefGoogle Scholar
5.Yersin, B, Frey, JG, Schaller, MD, et al. Fatal cardiac arrhythmias and shock following yew leaves ingestion. Ann Emerg Med 1987;16:1396-7, doi:10.1016/S0196-0644(87)80431-6.Google Scholar
6.Ruha, AM, Tanen, DA, Graeme, KA, et al. Hypertonic sodium bicarbonate for Taxus media-induced cardiac toxicity in swine. Acad Emerg Med 2002;9:179-85, doi:10.1111/j.1553-2712.2002.tb00241.x.Google Scholar
7.Cummins, RO, Haulman, J, Quan, L, et al. Near-fatal yew berry intoxication treated with external cardiac pacing and digoxin-specific FAB antibody fragments. Ann Emerg Med 1990;19:38–43, doi:10.1016/S0196-0644(05)82138-9.Google Scholar
8.Dahlqvist, M, Venzin, R, Konig, S, et al. Haemodialysis in Taxus baccata poisoning: a case report. QJM 2012;105:359-61, doi:10.1093/qjmed/hcr037.Google Scholar
9.Willaert, W, Claessens, P, Vankelecom, B, et al. Intoxication with Taxus baccata: cardiac arrhythmias following yew leaves ingestion. Pacing Clin Electrophysiol 2002;25:511-2, doi:10.1046/j.1460-9592.2002.00511.x.CrossRefGoogle ScholarPubMed
10.Babatasi, G, Massetti, M, Verrier, V, et al. [Severe intoxication with cardiotoxic drugs: value of emergency percutaneous cardiocirculatory assistance]. Arch Mal Coeur Vaiss 2001;94: 1386-92.Google Scholar
11.Auzinger, GM, Scheinkestel, CD. Successful extracorporeal life support in a case of severe flecainide intoxication. Crit Care Med 2001;29:887-90, doi:10.1097/00003246-200104000-00041.Google Scholar
12.Kolcz, J, Pietrzyk, J, Januszewska, K, et al. Extracorporeal life support in severe propranolol and verapamil intoxication. J Intensive Care Med 2007;22:381-5, doi:10.1177/0885066607307528.Google Scholar
13.Beckmann, A, Benk, C, Beyersdorf, F, et al. Position article for the use of extracorporeal life support in adult patients. Eur J Cardiothorac Surg 2011;40:676-80.Google ScholarPubMed
14.Panzeri, C, Bacis, G, Ferri, F, et al. Extracorporeal life support in a severe Taxus baccata poisoning. Clin Toxicol (Phila) 2010;48:463-5, doi:10.3109/15563650.2010.487487.CrossRefGoogle Scholar
15.Soumagne, N, Chauvet, S, Chatellier, D, et al. Treatment of yew leaf intoxication with extracorporeal circulation. Am J Emerg Med 2011;29:354–6, doi:10.1016/j.ajem.2010.03.017.Google Scholar
16.Scolletta, S, Taccone, FS, Nordberg, P, et al. Intra-arrest hypothermia during cardiac arrest: a systematic review. Crit Care 2012;16:R41, doi:10.1186/cc11235.Google Scholar