Post Your Cases > Lipid infusion in cardiac arrest after haldol injection

45 yo F presents to ER with chest pain and agitated behavior.ECG revealed nonspecific ST changes and prolonged QT interval. Pt given Toradol for CP and Haldol(2 mg) for agitation. Within 5-10 minutes, pt went into cardiac arrest. Rhythm was Vfib. Pt was shocked 4 times, still in Vfib. Placed on amiodarone, Vfib persisted. CPR performed during this time, and pt intubated and placed on vent. During code, pt was pulseless for most of code.At this point, brother was contacted who believed pt may have been on Wellbutrin to quit smoking.
Because os questionable drug history and bizarre behavior(interpreted as drug effect), decision made to attempt lipid infusion.
Within 1-2 minutes after infusion, pt spontaneously regained pulse, respirations, and BP. At this point, rhythm became SVT then converted to sinus tach.
ECG at this point revealed prolonged QT interval. Cardiac enzymes were negative.
Pt was extubated the following day, fully regained neurological fcn.
Pt recovery was at once dramatic and effective.
November 1, 2007 | Unregistered CommenterAggie Hewitt, MD
This is an important sentinal case. Not a sodium channel blocker, haldol is in the class of anti-psychotics that prolong QT and thereby increase the risk of sudden death. I believe this is the first time lipid has saved someone in toxin-associated cardiac arrest due to a QT prolonging agent. Aggie, thanks very much for the post. What was your role?
Guy
November 4, 2007 | Registered Commenter[Guy Weinberg]
Hello, and Thank you saving my life! To yourself, and Dr. Aggie Hewitt and the team that squuzed every second into that minute. Thank you again. I hope this gets noticed. This is truley a miracle drug, if it weren't for the avalability and the quick decision from Dr. Hewitt and her team, I would not be here today. Thank you once again. I am doing GREAT now.
March 18, 2008 | Unregistered CommenterEmily A. Smart
Thank you very much, too.
I agree, the entire team at Riddle Hospital did an incredible job. So glad to hear from you and particularly that you're doing well. This is very heartening for us all.
Thanks again.
Guy
March 18, 2008 | Registered Commenter[Guy Weinberg]
I came across some interesting literature by Marfella demonstrating that acute rises in free fatty acid actually prolongs the QTc. Any comments?

See "Elevated plasma fatty acid concentrations prolong cardiac repolarization in healthy subjects." Pub Med ID = 11124745
September 23, 2008 | Unregistered Commenterchopk51450
Thank you. That is indeed a very interesting study. Brave volunteers getting i.v. lipid followed by heparin. The choice of metrics and their analysis are excellent - and the effects are at least theoretically applicable to the setting of lipid rescue....though most patients won't get a heparin bolus. However, the effect is nicely tied to epinephrine elevations and most (tho not all) patients in this setting will get relatviely large doses of epinephrine.
I think this work also dovetails nicely with the older papers by PB Corr (eg. PMID: PMID: 8261598).
Many thanks for the reference.
Guy
September 25, 2008 | Unregistered Commenter[Guy Weinberg]