Successful Use of Early Therapeutic Hypothermia in an MDMA and Amphetamine Intoxication–Induced Out-of-Hospital Cardiac Arrest: A Case Report

Abstract

Deaths caused by recreational drug abuse have increased considerably in recent years. Therapeutic hypothermia offers the potential to improve neurological outcomes in post-resuscitation patients. A 19-year-old man was brought to our emergency department after suffering out-of-hospital ventricular fibrillation (VF) cardiac arrest. He was resuscitated at our emergency department again due to VF. Urine analysis showed high levels of amphetamine and 3,4 methylenedioxymethamphetamine (MDMA) (ecstasy). The patient was intubated, sedated, and ventilated. Within 1h after the return of spontaneous circulation and hemodynamic stabilization, therapeutic hypothermia was initiated for neurologic protection. An external-cooling device was used for cooling. He was maintained at 33oC for 72h. The patient was weaned from the ventilator and extubated on day 5. He was discharged from the hospital on the day 10 with good cerebral performance. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Initiation of early therapeutic hypothermia within 1h after return of spontaneous circulation might contribute to better neurologic outcome in patients who suffer VF cardiac arrest. We suggest that early therapeutic hypothermia may be considered in patients who suffer out-of-hospital cardiac arrest due to MDMA and amphetamine intoxications.