Venoarterial extracorporeal membrane oxygenation for vasoplegic shock after treprostinil refill of an implanted intravenous pump: a case report

Venoarterial extracorporeal membrane oxygenation (ECMO) is a rescue therapy that can stabilize patients with hemodynamic compromise. Indications continue to evolve, including drug overdose. However, the indication merely for vasoplegic shock following drug overdose is controversial. We report a case...

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Published in:Frontiers in cardiovascular medicine 2024, Vol.11, p.1348311
Main Authors: Valencia, Lucía, López, Sergio, Olivas, Ana, Becerra, Ángel, Alemán-Segura, María Desirée, Évora-García, Marta, Ojeda, Nazario, Cabrera, Leonardo, Rodríguez-Pérez, Aurelio, Pérez-Peñate, Gregorio
Format: Article
Language:English
Subjects:
case report
overdose
treprostinil
VA-ECMO
vasoplegic shock
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Summary:Venoarterial extracorporeal membrane oxygenation (ECMO) is a rescue therapy that can stabilize patients with hemodynamic compromise. Indications continue to evolve, including drug overdose. However, the indication merely for vasoplegic shock following drug overdose is controversial. We report a case of a 57-year-old male with high-risk idiopathic pulmonary arterial hypertension treated with upfront triple combination therapy (sildenafil, bosentan, and intravenous treprostinil infusion via subcutaneous abdominal implantable pump). In one of the refills of the drug reservoir, accidental administration of 1 months's supply of treprostinil (200 mg) into the subcutaneous tissue occurred, causing refractory vasoplegic shock. He required urgent VA-ECMO for 96 h, surviving to discharge 28 days later. Treprostinil poisoning is rare due to its less frequent use but is life-threatening. ECMO may be considered in vasoplegic shock due to overdose of vasodilatory medication. It allows organ perfusion to be maintained, with the knowledge that recovery is as rapid as drug elimination.
ISSN:2297-055X
2297-055X
DOI:10.3389/fcvm.2024.1348311