Abstract 15659: Bupropion Overdose Requiring Veno-Arterial Extracorporeal Membrane Oxygenation

• DOI: 10.1161/circ.148.suppl_1.15659
• Publication Date: 2023-12-19T08:08:02Z
• Authors: Stephanie Golob; Peter Ting; Kyle Pires; Vanessa Soetanto; Benjamin Pagano; Kah-Loon Wan; Sylvie Hall; Lauren Bianco; Joseph Hawkins; Hannah Schimmer; Victoria Yunaev; William Howe; Jessica Landau; Allison Greco; Radu Postelnicu; Rafael Harari; Silas Smith; James Horowitz; David Park; Norma Keller; Sripal Bangalore; Stuart Katz; Carlos Alviar
• Keywords: Bupropion; Transthoracic echocardiogram

Introduction: Bupropion is a monocyclic antidepressant that inhibits dopamine and norepinephrine reuptake, with significant risk cardiotoxicity in overdose cases. Case: A 32-year-old transgender man history of Human Immunodeficiency Virus (on anti-retroviral therapy), poly-substance use disorder, depression presented an intentional bupropion overdose. On arrival the patient was noted to have seizures decreased mental status. He intubated treated anti-epileptic medication. Initial EKG sinus tachycardia QTc 456 milliseconds. Transthoracic echocardiogram (TTE) showed severely reduced left ventricular ejection fraction (LVEF) worsened over 6 hour period from 40% 25%. Serial EKGs progressive prolongation 635 Cardiac catheterization demonstrated angiographically normal coronary arteries Index 2.5 L/min/m 2 . Due rapidly prolonging (VT), decision proceed Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) cannulation after multidisciplinary shock team discussion. few hours cannulation, suffered hemodynamically unstable VT, requiring electrical cardioversion (DCCV) brief return rhythm (SR) subsequent VT recurrence, responded lidocaine repeat DCCV. ECG normalized decannulated VA ECMO on hospital day 4. Repeat TTE recovery LVEF 60%. The extubated discharged psychiatric rehabilitation. Conclusion: Cardiogenic arrhythmias are well recognized complications toxicity likely due gap junction inhibition. should be considered as part assessment for patients at high hemodynamic or collapse toxidromes marked cardiotoxicity.