Key result
Addition of levosimendan and subsequent ECMO resulted in prompt stabilization of haemodynamics and successful management of pulmonary failure in a patient with prostaglandin-induced cardiac arrest.
Case Report (n=1)
Levosimendan and ECMO successfully stabilized a patient with catecholamine-resistant cardiac arrest and pulmonary failure induced by high-dose prostaglandins.
Hypothesis-generating for levosimendan-ECMO rescue in prostaglandin-induced arrest; prospective validation required.
BACKGROUND: Administration of high doses of prostaglandins is a frequently performed and effective method for the treatment of atonic uterine haemorrhage in order to increase uterine muscle tone. Rarely, however, these drugs may cause life-threatening complications including bronchospasm, acute pulmonary oedema and myocardial infarction caused by coronary spasms. METHODS: We discuss the management of a patient suffering post-partum atonic uterine bleeding, catecholamine-resistant cardiac arrest and fulminant pulmonary failure due to deleterious side-effects of treatment with prostaglandins. RESULTS: During therapy resistant cardiopulmonary resuscitation, the addition of levosimendan to standard medications resulted in a prompt stabilization of haemodynamics. Subsequent treatment of pulmonary failure was successfully managed with ECMO. CONCLUSION: Although levosimendan is not approved for pharmacological treatment of cardiopulmonary arrest, the beneficial effects in this patient suggest an important role of calcium sensitization and vasodilation during prostaglandin-induced cardiac arrest.
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Krumnikl et al. (2006) conducted a case report in Prostaglandin-induced post-partum cardiac arrest and fulminant pulmonary failure (n=1). Levosimendan and extracorporeal membrane oxygenation (ECMO) was evaluated on Stabilization of haemodynamics and management of pulmonary failure. Addition of levosimendan and subsequent ECMO resulted in prompt stabilization of haemodynamics and successful management of pulmonary failure in a patient with prostaglandin-induced cardiac arrest.
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