Extracorporeal membrane oxygenation support in refractory perioperative anaphylactic shock to rocuronium: a report of two cases. (November 2019)

• Record Type: Journal Article
• Authors: Carelli, Matheus; Seco, Michael; Forrest, Paul; Wilson, Michael K; Vallely, Michael P; Ramponi, Fabio
• Is Part Of: Perfusion. Volume 34:Number 8(2019)
• Page Start: 717
• Page End: 720
• Publication Date: 2019-11
• Subjects: extracorporeal membrane oxygenation -- anaphylaxis -- anaphylactic shock -- rocuronium -- perioperative arrest; Perfusion (Physiology) -- Periodicals; Blood -- Circulation, Artificial -- Periodicals; Heart -- Surgery -- Periodicals; Extracorporeal Circulation -- Periodicals; Perfusion -- Periodicals; Circulation extracorporelle -- Périodiques; Perfusion -- Périodiques; 617.41
• DOI: 10.1177/0267659119842813
• Languages: English
• ISSNs: 0267-6591

Abstract

In recent years, extracorporeal membrane oxygenation has become increasingly common in the treatment of in-hospital cardiac arrest in non-cardiac surgery patients. This includes cardiac arrest secondary to perioperative anaphylactic shock refractory to standard advanced life support protocols, which is a rare but catastrophic event associated with significant mortality. Neuromuscular blocking drugs are most commonly implicated in perioperative anaphylaxis, with rocuronium playing a major role. In this article, we report two cases of young and otherwise fit and well patients who experienced a perioperative arrest secondary to rocuronium anaphylaxis before elective surgery; both patients did not respond to conventional advanced life support, but survived neurologically intact after institution of urgent veno-arterial extracorporeal membrane oxygenation.