Symmetrical digital gangrene after a high dose intravenous infusion of epinephrine and dopamine following resuscitation from cardiac arrest

Symmetrical digital gangrene (SDG) is mostly due to low cardiac output and disseminated intravascular coagulation (DIC) (table 1).1 We describe a 36-year-old right-handed man with SDG requiring amputation of 14 digits. He had received continuous intravenous infusion of epinephrine and dopamine given for a cardiac arrest that developed 1 hour after resection of a meningioma (table 2). In cardiogenic shock, he had decreased responsiveness, sinus tachycardia (135 bpm) and arterial hypotension (50/45 mm Hg). Advanced cardiac life support with mechanical ventilatory support was instituted. The administration of inotropic agents stabilised blood pressure to around 110/65, heart rate at 98 and mean arterial pressure (MAP) at 70 mm Hg. The patient's responsiveness improved gradually, but cardiovascular instability made him inotropic dependant. View this table: Table 1 Causes of symmetrical digital gangrene View this table: Table 2 Drug therapy On day 3 postcardiac arrest, acute gangrene of the tips of 10 toes and right 4 fingers developed. There was painful inflammatory oedema with erythematous reaction in the regions of demarcation between the normal and the gangrenous areas. All …