Early Amiodarone Use in A Patient With COVID-19 Pneumonia

Waddah Maskoun

doi:10.34297/ajbsr.2020.10.001468

Abstract

Coronavirus disease 19 (COVID-19) has caused a global pandemic since its emergence in late 2019. Most cases cause a mild self-limiting disease, but it can also lead to a variety of organ failure and most notably respiratory failure. To date there is no clinically proven treatment for COVID-19 infection. Amiodarone was shown to have in-vitro activity against Filovirus species with potential antiviral activity against SARS-CoV-2. The current case describes the clinical response after starting amiodarone in critically ill COVID-19 patient with multi organ failure. Here we present a case of a 66-years old male who developed acute respiratory distress syndrome (ARDS) secondary to COVID-19 infection requiring mechanical ventilation, renal failure requiring renal replacement therapy, and significant encephalopathy He was started on amiodarone to control his atrial fibrillation and we noticed significant drop in his oxygen requirements afterwards resulting in early liberation from the ventilator. Our patient had a measurable clinical improvement after starting amiodarone and he was liberated from the ventilator within less than 48 hours which is atypical for COVID-19 induced ARDS. We here present our observation in an attempt to explore the potential role of amiodarone in management of COVID-19 infection especially if introduced early in the course of the disease.

Highlights

Novel coronavirus disease-19 (COVID-19) is a global pandemic disease with multiorgan involvement [1]
The patient is a 66-years old male with a history of hypertension, diabetes mellitus type 2, obesity with body mass index of 40, chronic kidney disease stage-III, and paroxysmal atrial fibrillation who presented with 1 week of fever, chills, altered mental status and shortness of breath with a productive cough
Intravenous (IV) and oral Amiodarone were started 9 hours after intubation to control his atrial fibrillation. He required high oxygen support with a Arterial Partial Pressure of Oxygen (PaO2): FiO2% ratio of 158 initially which was consistent with moderate acute respiratory distress syndrome (ARDS)

Summary

Introduction

Novel coronavirus disease-19 (COVID-19) is a global pandemic disease with multiorgan involvement [1]. The patient is a 66-years old male with a history of hypertension, diabetes mellitus type 2, obesity with body mass index of 40, chronic kidney disease stage-III, and paroxysmal atrial fibrillation who presented with 1 week of fever, chills, altered mental status and shortness of breath with a productive cough. Upon presentation his blood pressure was 102/55 mmHg, heart rate 121 beats per minute, respiratory rate 25 breaths per minute, temperature 38.3°C, and his oxygen saturation was 86% on room air.

Results

Conclusion