難治性不整脈に対して経皮的心肺補助（ＰＣＰＳ）を施行し救命しえたトリカブト中毒の１例

Abstract

A 63-year-old female was transferred to our critical care center due to a loss of consciousness. During the first examination, the patient's level of consciousness was JCS 200, blood pressure was unmeasurable, and ECG showed multifocal premature ventricular contractions. She was intubated and treated with the anti-arrhythmic drugs and cardioversion, however, these had no effect. Her ventricular arrhythmia was intractable and hemodynamics was unstable, therefore we applied a percutaneous cardio-pulmonary support (PCPS). After she was admitted to ICU, her family found the root of a plant in her bag, and we could then diagnose it as aconite poisoning. Ventricular arrhythmia returned to sinus rhythm 22 hours after admission, and the PCPS was wore off on the 3rd hospital day. Aconitine, mesaconitine and jesaconitine were detected in the serum. The level of these aconitum alkaloids decreased gradually to become undetectable two days later. We must keep aconite poisoning in mind as the cause of an intractable ventricular arrhythmia. It is important to apply PCPS without delay to maintain the hemodynamics in the case of aconite poisoning resistant to anti-arrhythmic drugs and cardioversion.