LipidRescue™ Resuscitation

On 1/4/11, an 82-year old, 91kg male presented to our ambulatory surgical center for a carpal tunnel release, ulnar nerve release, and a trigger finger release. He had a PMH significant for nonischemic cardiomyopathy (EF 40%) and recent onset of ventricular bigeminy. The patient was cleared by his cardiologist for surgery. Following the administration of 15ml each of Mepivacaine 2% and Ropivacaine 0.5% for an ultrasound guided interscalene block, the patient began seizing and developed wide complex tachycardia. Midazolam was administered, the patient was intubated, a code was called, and compressions were started. Epinephrine, vasopressin, and amiodarone were administered; and intralipid 20% was bolused. The patient was defibrillated at 120J and converted to sinus. When the intralipid infusion was slowed after the initial bolus, the patient developed bradycardia and PEA. Compressions were started again for 2 minutes and we increased the rate of the lipid infusion. Epinephrine, atropine, and ephedrine were administered. The patient stabilized and was transferred via ambulance to the ICU at the hospital. Within one hour in the ICU, the patient became progressively more awake. He was extubated and the lipid infusion was discontinued. Overall, the patient received almost a total of 8ml/kg, which is the maximum noted on the protocol. The patient was monitored and remained stable throughout his stay. He was discharged on 1/7/11.

Thank you Jeffrey for this interesting post.
I would be keen to know the volume of the initial Intralipid bolus the patient received and the rate of Intralipid infusion (in ml/kg/hr) that was commenced thereafter. Would you be able to indicate the approximate volume of Intralipid already given when the infusion rate was decreased and the patient developed PEA and how long after the initial seizures this event occurred?

David,

Sorry for the delayed response, but hopefully this will answer your question. The initial bolus that was given was about 135ml and then the rate was 0.25ml/kg/hr. The patient then developed the PEA about 3 minutes after the bolus was completed. The initial seizure activity started approximately 30 minutes prior to the PEA and 10-15 minutes prior to any Intralipid being started.