Case Report

Cardiopulmonary Bypass Support for Tricyclic Poisoning: A Case Report

Providence Medical Center, Portland, Oregon

^* Address correspondence to: Carl Sheppard, Providence Medical Center, 4805 NE Glisan Street, Portland, OR 97230

Abstract

Cardiopulmonary bypass as an adjunct to the treatment of acute tricyclic antidepressant poisoning has not been well documented in the literature. In December of 1993, Providence Medical Center used such an adjunct for cardiac support on a 17 year old male with acute tricyclic antidepressant poisoning. The patient had ingested 2500 to 3500 mg of imipramine. Lab tests confirmed imipramine ingestion and ruled out alcohol, acetaminophen or salicylate combinations. The patient arrived via ambulance to the emergency room with a coarse supraventricular rhythm with wide QRS complexes. Over the next 20 minutes the QRS complex became increasingly wider and the rhythm more bizarre until pulses were lost. Repeated attempts to correct the dysrhythmia were unsuccessful and cardiopulmonary resuscitation was eventually initiated. The patient was transported to the operating room and placed on cardiopulmonary bypass. After several hours of bypass and charcoal hemoperfusion, the patient's cardiac rhythm improved to a supraventricular rhythm. The patient was weaned from bypass and transferred to the cardiac care unit where hemodetoxification continued. Postoperatively the patient had a cardiac index of 2.4 L/min/m² and systemic vascular resistance of 942 dynes/sec/cm^-5 on norepinephrine of 2 mcg/kg/min. Imipramine and desipramine levels were down to 250 ng/ml and 500 ng/ml respectively. Neurologic function, however, did not resume and life support was terminated on postoperative day three.