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Rescue extracorporeal membrane oxygenation therapy in methamphetamine toxicity

  • Laura K. Morrison (a1), J Kromm (a2), J Gaudet (a2), D Zuege (a2), B Button (a3), F Warshawski (a2) and SN Lucyk (a3) (a4)...

Abstract

Complications related to methamphetamine use and abuse are common presentations seen in the emergency department. Standard management focuses on addressing the central nervous system and cardiovascular effects with the use of sedation and hemodynamic support. We describe a case report of a patient with methamphetamine toxicity and subsequent severe cardiomyopathy refractory to conventional management that responded to cardiovascular support with extracorporeal membrane oxygenation therapy (ECMO). A 22-year-old female was admitted in severe cardiogenic shock following intravenous administration of methamphetamine and oral fentanyl use. Despite aggressive treatment with benzodiazepines, intravenous fluids, vasopressors, vasodilators, antibiotics and inotropes, the patient’s clinical status deteriorated, and she suffered a cardiac arrest. The patient was successfully resuscitated, and following the return of spontaneous circulation, ECMO was initiated. After 82 hours the patient was successfully weaned from ECMO with the recovery of her left ventricular function and no neurologic sequelae. The patient developed leg ischemia requiring embolectomy and open repair as a complication of ECMO cannulation. In our case, ECMO was used successfully in treating severe cardiac dysfunction from acute methamphetamine-induced cardiomyopathy and was used as a bridge to recovery. The complications seen in this patient emphasize the potential risks associated with this intervention and highlight the need for careful patient selection.

Les complications liées à la consommation et à l’usage abusif des méthamphétamines sont chose courante au service des urgences. Le traitement habituel consiste principalement en la protection du système nerveux central et en la neutralisation des effets cardiovasculaires par la sédation et l’assistance hémodynamique. Sera exposé ici un cas d’intoxication aux méthamphétamines, accompagnée d’une cardiomyopathie grave, réfractaire au traitement usuel, qui a réagi favorablement à l’assistance cardiovasculaire à l’aide de l’oxygénation par circulation extracorporelle (OCEC) sur oxygénateur à membrane. Une jeune femme de 22 ans a été admise à l’hôpital en état de choc cardiogénique grave, suivant l’administration intraveineuse de méthamphétamines et la prise de fentanyl par voie orale. Malgré un traitement énergique, composé de benzodiazépines, de l’administration intraveineuse de liquides, de vasopresseurs, de vasodilatateurs, d’antibiotiques et d’inotropes, l’état clinique de la patiente a continué à se détériorer et il s’en est suivi un arrêt cardiaque. Après des manœuvres de réanimation couronnées de succès et un retour spontané à la circulation sanguine, nous avons entrepris l’OCEC. La patiente a été sevrée du traitement au bout de 82 heures, et ce, sans séquelles neurologiques; le fonctionnement ventriculaire gauche s’est également rétabli. Toutefois, une ischémie nécessitant une embolectomie et une réparation chirurgicale s’est développée dans la jambe, complication de la canulation. Dans le cas décrit ici, le recours à l’OCEC, utilisée comme mesure de transition, a permis de corriger un dysfonctionnement cardiaque grave, secondaire à une cardiomyopathie aiguë liée à la prise de méthamphétamines. La complication observée chez la patiente fait ressortir les risques associés à l’intervention et la nécessité d’une sélection rigoureuse des candidats au traitement.

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Copyright

Corresponding author

Correspondence to: Dr. Laura K. Morrison, 1280 Main St W, Hamilton, ON, L8S 4K1; Email:laura.morrison@medportal.ca

References

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