Norepinephrine
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Lack of efficacy: case report. A 65-year-old man exhibited lack of efficacy during treatment with norepinephrine for arterial hypotension. The man, presented with COVID-19 pneumonia. He had a distributive shock and hyperinflammation including interleukin 6996 pg/mL, ferritin 3233 mg/dL, fibrinogen 8.8 g/dL and D-dimer 895 ng/mL. He received off label treatment with ceftriaxone, tocilizumab, hydroxychloroquine and azithromycin for 5 days [routes and dosages not stated]. Subsequently, he required unspecified low dose vasoactive drugs, prone positions and mechanical ventilation. He developed myocarditis associated with viral infection, increased highly sensitive troponin, and right overload with cytolysis and hyperbilirubinaemia. On day 6, while in a prone position, he developed arterial hypotension following pulseless electrical activity which was nonresponsive to norepinephrine [route and dosage not stated]. Transthoracic ultrasound showed 3cm thick pericardial effusion in the posterior and anterior compartment with no right ventricular dilation. Pericardiocentesis was performed following advance life support and extraction of serous fluid from the anterior compartment, without return of spontaneous circulation (ROSC). Thirty minutes after ROSC, he died, which was oriented as a cardiac arrest secondary to cardiac tamponade following pericardial effusion due to viral myocarditis. Ruiz-Rodriguez JC, et al. Cardiac tamponade as a cause of cardiac arrest in severe COVID-19 pneumonia. Resuscitation 155: 1-2, Oct 2020. Available from: URL: http:// 803498731 doi.org/10.1016/j.resuscitation.2020.07.008
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Reactions 29 Aug 2020 No. 1819
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