Extracorporeal Cardiopulmonary Resuscitation in a Cardiac Arrest Patient Due to Digoxin Overdose Who Was Awake During Conventional Cardiopulmonary Resuscitation

Abstract

Introduction: Digoxin overdose, which may cause rhythm disturbances, such as atrioventricular blocks, can ultimately cause cardiac arrest. Extracorporeal life support may provide time until specific antidotes show an effect. Case Report: A 75-year-old male patient presented with dyspnea with a known history of congestive heart failure. His medications included digoxin, and his initial electrocardiography showed an idioventricular rhythm. His digoxin level was over the upper normal limit, and he had hyperkalemia (7.9 Meq/L). The patient collapsed during conventional therapies, including insulin-glucose infusion, atropine administration, and catheterization for emergency hemodialysis, and while awaiting digoxin-specific fragment antibodies. During mechanical cardiopulmonary resuscitation, the patient was awake and had a Full Outline of Unresponsiveness score of 8, which led us to initiate veno-arterial extracorporeal membrane oxygenation. Conclusion: Extracorporeal Cardiopulmonary Resuscitation, might be a useful option for intoxicated patients when conventional therapies fail. However, more experience is needed for the increase in survival rate.