Cardiac Arrest Reported During First Cycle of High Dose Cisplatin Intravenous Infusion at a Tertiary Care Hospital Karachi, Pakistan

Abstract

Rationale: Cardiac toxicity with cisplatin is not common, therefore the cardiac evaluation and investigations are not performed routinely before giving high dose cisplatin unless there are risk factors. After this incident of cardiac arrest there is a need to be more vigilant. Patients History: 48 years old male diagnosed case of squamous cell carcinoma tongue was electively admitted for the infusion of chemotherapeutic drug high dose Cisplatin (100 mg/m2) at daycare oncology. The patient in this case had no previous history of high blood pressure, high cholesterol level, cardiac problem, chest pain or chest discomfort. There is no prior history of hypertension, dyslipidemia, any cardiac anomaly, chest pain or discomfort. He also denied any history of addiction including any form of tobacco or alcohol. All baseline investigations, including complete blood count, Liver function test, serum creatinine, 24 hours ‘urine for creatinine clearance, serum electrolytes, hepatitis B and C were normal. Tissue biopsy, CT scan and ECHO prior to treatment was normal. Patients, as per instruction of primary physician has to receive cisplatin 100mg /m2 concurrent with radiation therapy. Result: Patient suddenly became unconscious in washroom after receiving 50% of cisplatin infusion, as per chemotherapy protocol patient must receive potassium and magnesium in infusion over three hours as per standard guidelines, patient remains well after receiving this electrolytes infusion. After giving pre-chemotherapy which included injection Ondansetron 8 mg. Injection dexamethasone 12 mg and tablet aprepitant 125 mg and capsule esomeprazole 40 mg and after giving pre-chemotherapy injection cisplatin 100 mg/m2 intravenous started infusion duration was over one hour after half an hour of infusion patient wants to go for passing urine and went with attendant to wash room, he suddenly becomes unresponsive, this event was identified by attendant when patient not came back from washroom who was standing near door. Despite multiple cycles of CPR, the patient could not be revived and remained in asystole. Death was declared to the family members after 45 minutes.