Reactions 454 - 5 Jun 1993

SDesipramine

Heart disorders treated with extracorporealmembrane oxygenation in an infant: case report

An 18-month-old infant girl was admitted after ingesting anunknown quantity of desipramine (Norpamin®). She wasunresponsive, cyanotic and stuporous and had seizure activity.Her HR was 60 beats/min and BP was 72/8mm Hg. Arterialblood gases indicated a severe metabolic acidosis, and herinitial serum desipramine concentration was > 3000 ng/ml(toxic level > 1000 ng/ml).

Despite prolonged resuscitative and supportive therapy,including treatment with a transvenous pacemaker,bradycardia and hypotension persisted. Thus, the infant wastreated with extracorporeal membrane oxygenation (ECMO).Ventricular tachycardia and asystole had also developedrequiring cardiopulmonary resuscitation.

ECMO was initiated around 10 hours after admission andmaintained for 60 hours. Over several days, the serumdesipramine concentration gradually fell and the cardiacabnormalities resolved. Imaging scans within the next 10 daysshowed small cerebral infarcts, but at discharge the onlyneurologic abnormality was mild weakness which hadresolved at 6 months’ follow-up.

Author comment: ECMO has previously been limited to usein neonates with severe cardiopulmonary failure or for cardiacsupport following surgery. ‘However, its use for drug overdosehas not been reported’. This case demonstrates that it ‘shouldbe considered in paediatric patients with severe, but temporary,cardiac dysfunction due to a life-threatening drug overdose.’Goodwin DA, et al. Extracorporeal membrane oxygenation support for cardiacdysfunction from tricyclic antidepressant overdose. Critical Care Medicine 21:625-627, Apr 1993 - USA 800195880

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Reactions 5 Jun 1993 No. 4540114-9954/10/0454-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved