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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 66-year-old woman developed hyperkalaemia, wide complex polymorphic ventricular tachycardia and cardiac arrest following treatment with suxamethonium chloride [route, time to reactions onsets and outcomes not stated].
The woman, who had serious acute respiratory distress syndrome secondary to COVID-19 infection, was admitted in ICU on a mechanical ventilator. After 17 days of hospitalisation, her clinical situation improved and she was extubated. However, 1 day after extubation, she developed sudden respiratory deterioration with severe haemoglobin oxygen desaturation. Despite receiving oxygen 100% via a facemask, oxygen saturation only reached to 80%−85%. As hypoxaemic cardiac arrest was imminent, she was reintubated using rapid sequence induction (RSI). Thereafter, anaesthesia was given with suxamethonium chloride [succinylcholine; route not stated] 1 mg/kg along with propofol and fentanyl, and she was successfully intubated. About 60 seconds after intubation, her heart rhythm converted into a wide complex polymorphic ventricular tachycardia that resulted in cardiac arrest.
Immediately, the woman underwent resuscitation with effective chest compressions and ventilation. Rhythm check 2−3min after the arrest confirmed ventricular fibrillation, with defibrillation immediately after one shock of 200J. A single bolus of epinephrine and magnesium sulfate was given. A second rhythm check 2−3min later revealed a stable arterial pulse and invasive systolic BP above 110mm Hg. A wide complex rhythm in association with a narrow complex was noted. She was suspected to have hyperkalaemia secondary to suxamethonium chloride. Hence, calcium chloride was administered. About 4−5min after the suxamethonium chloride administration, a blood gas sample showed a potassium of 6.4mM. Over the following 10min, her condition stabilised, and the ECG normalised to normal sinus rhythm as potassium decreased to 4.2 mM.
Reference
- Sigurdsson TS, et al. Cardiac arrest in a COVID-19 patient after receiving succinylcholine for tracheal reintubation. British Journal of Anaesthesia 125: e255-e257, No. 2, Aug 2020. Available from: URL: 10.1016/j.bja.2020.04.073 [DOI] [PMC free article] [PubMed]