Intra-aortic balloon pump for the treatment of severe verapamil poisoning

Abstract

A 15-years-old girl was admitted to the intensive care unit 9 hours after ingesting 7.2 gr of sustained-release verapa-mil (144 mg/kg). The electrocardiogram revealed complete atrioventricular block with prolonged QRS duration and ventricular rate of 40 beats/min. The patient was intubated and received artificial ventilation. Gastric lavage was initiated with charcoal by nasogastric tube. A transvenous pacemaker and a 7 Fr thermodilution catheter was inserted via internal juguler and left subclavian vein, respectively. The cardiac index was 1.7 Iiters/m2/min. Oliguria persisted at this stage. Despite vigorous fluid resuscitation, cardiac pacing, calcium and high doses of vasopressor administration, blood pressure and cardiac index did not increase. Therefore, 48 hours after ingestion, intra-aortic balloon pump (IABP) was used to restore cardiac output and to allow sufficient time for liver detoxification. The IABP increased systolic blood pressure to 95 mm Hg and cardiac index to 2.9 Iiters/m2/min within 30 minutes time and initiated diuresis. The patient was djscharged 9 days after admission without sequale. In the present case, the value of IABP was emphasized in verapamil induced circulatory failure which is unresponsive to aggresive gut decontamination and high dose inotropic therapy.