Is lipid rescue effective in cardiac arrest due to local anaesthetic toxicity?
Date First Published:
January 17, 2007
Last Updated:
January 29, 2007
Report by:
Rebecca Preece, SHO (Weston General Hospital)
Three-Part Question:
[In cardiac arrest caused by local anaesthetic toxicity] does [lipid rescue][improve survival]?
Clinical Scenario:
An elderly lady sustains a displaced Colles fracture that needs manipulating. She is given a Bier's block. Two minutes after the injection of prilocaine, she has an asystolic cardiac arrest. Resuscitation commences following ALS protocols, but after ten minutes, she remains asystolic. Should lipid rescue be used in this situation?
Search Strategy:
Medline 1966 to 12/99 using the OVID interface
Search Details:
"Anesthetics, Local"[MeSH] AND "Heart Arrest"[MeSH] AND "Lipid"[MeSH] Limit to human.
Outcome:
Five papers of which two were case reports and three were irrelevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Successful resuscitation of a patient with ropivicaine-induced asystole after axillary plexus block RJ Litz, M Popp, SN Stehr, T Koch 2006 Germany | 84 year ol female | case report | Return of spontaneous circulation after cardiac arrest | Initial resuscitation from cardiac arrest unsuccessful | |
| Successful use of a 20% lipid emulsion to resuscitate a patient adter a presumed bupivicaine-related cardiac arrest Rosenblatt MA, Abel M, Fischer GW, Itzovich CJ, Eisenkraft JB 2006 USA | 58 year old man | case report | Return of spontaneous circulation of cardiac arrest | Initial resuscitation from cardiac arrest unsuccessful |
Author Commentary:
The only published data on this subject is in the form of case reports. There is no higher level evidence. There is no definite evidence to confirm that intralipid is effective in cardiac arrest due to local anaesthetic toxicity. However, two case reports describe its use.
Bottom Line:
It is reasonable to give lipid emulsion in cardiac arrest due to lipid toxicity.
References:
- RJ Litz, M Popp, SN Stehr, T Koch. Successful resuscitation of a patient with ropivicaine-induced asystole after axillary plexus block
- Rosenblatt MA, Abel M, Fischer GW, Itzovich CJ, Eisenkraft JB. Successful use of a 20% lipid emulsion to resuscitate a patient adter a presumed bupivicaine-related cardiac arrest