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Necrosis: case report A 53-year-old man developed necrosis following treatment with epinephrine [adrenaline] and a thrombolytic. The man, who had suspected acute respiratory failure, developed a ventricular fibrillation cardiac arrest. He received CPR with chest compressions, and an intraosseous catheter was placed in his proximal tibia. Despite resuscitation and an epinephrine injection [dose not stated], he remained in asystole. He had a collapsed left ventricle and marked right ventricle dilatation. Thrombolysis was given with the intraosseous (IO) administration of Acteplase [sic] 0.6 mg/kg for a suspected massive pulmonary embolism. Sinus rhythm was restored. Femoral venous access was established, and the IO catheter was removed. In the ICU, he received treatment successfully for post cardiac arrest syndrome with multiorgan failure. Few residual neurological sequelae remained. On day 13, 48 hours after IO catheter removal, necrosis was seen in the IO insertion area [time to reaction onset not clearly stated]. The necrosis was large, extensive and on the anteromedial side of his right leg. Medical treatment was unsuccessful, and the patient underwent surgical excision followed by vacuum-assisted closure. He received vacuum therapy with repetitive surgical dressing. He had persistent ulceration on the whole anteromedial side of his right leg with direct bone exposure. In the ensuing weeks, surgical grafting was performed successfully. Author comment: "In our case, thrombolysis may have caused subcutaneous bleeding, inducing local pressure necrosis. . . [N]ecrosis can be linked to [epinephrine] extravasation and local ischaemia." Landy C, et al. Complication of intraosseous administration of systemic fibrinolysis for a massive pulmonary embolism with cardiac arrest. Resuscitation 803078546 83: e149-150, No. 6, Jun 2012 - France

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Reactions 20 Oct 2012 No. 1424