LipidRescue™ Resuscitation

We report a case of an 84yr old, ASA 2, 70kg, lady admitted with a left neck of femur fracture. A fascia iliaca compartment block was performed preoperatively in the emergency department for analgesic purposes, in keeping with local guidelines. The landmark technique was used and 30mls 0.25% levobupivacaine was injected, with pauses for negative aspiration after every 5 mls.

Approximately 45 seconds following this uneventful block, the patient complained of feeling “funny.” She rapidly became unresponsive but continued to maintain a patent airway with spontaneous ventilation and a carotid pulse was palpable. Before the cardiac rhythm could be assessed, the patient had a tonic-clonic seizure, 5mg of IV diazepam and high flow oxygen were administered. The ECG showed sinus bradycardia with broad complex ectopics but a carotid pulse remained palpable.

While waiting for the intralipid to be retrieved, the patient deteriorated into PEA cardiac arrest, CPR was commenced, the patient was intubated and the ALS algorithm for non-shockable cardiac arrest was followed for 4 cycles. IV adrenaline 1mg of 1:10,000 was given. 20% Intralipid was administered within 5-8 minutes of loss of consciousness. AAGBI guidelines were followed, administering a bolus and starting an infusion and a total of 500ml 20% Intralipid was administered. Soon after the commencement of the infusion there was return of cardiac output, associated with an irregular bradycardia at rate of 35 bpm. Two bolus doses of 500mcg atropine were administered with little effect so the infusion of intralipid was continued. External pacing was commenced then discontinued after 10 minutes as the patient was maintaining a heart rate of 70 and a stable BP. The patient was transferred intubate and ventilated to ITU, she did not require any additional cardiovascular support she underwent a left hemiarthroplasty 24 hours later and was successfully extubated on ITU post operatively. With seemingly a full neurological recovery, she was discharged to the orthopaedic ward after 3 days.