Prolonged Cardiac Arrest in Severe Bupropion Intoxication: Everything You Should Know
About Anti-Arrhytmics, Transesophageal Echocardiography Guided Resuscitation and
Extracorporeal Membrane Oxygenation.
Bupropion is a commonly prescribed antidepressant used for treating major depressive disorder,
seasonal affective disorder as well as for anxiety, bipolar disorder and as an aid for smoking
cessation. Bupropion is classified as an atypical monocyclic antidepressant with a chemical
structure similar to amphetamine.
It is a selective reuptake inhibitor of dopamine and norepinephrine Bupropion is available in
an immediate release, a sustained release and an extended release form.
Inflammatory markers, liver function tests, complete blood count
and renal panel were all within normal ranges.
Over the next 8-hours the patient developed a bradycardia as low as 47 bpm with widening
of the QRS-complex up until 185 ms and prolongation of the QTc interval up to 519 ms.
Bupropion is classified as an atypical monocyclic antidepressant with a chemical structure
similar to amphetamine. It is a selective reuptake inhibitor of dopamine and norepinephrine.
Overall, the most described symptoms after intoxication are vomiting, hypertension,
sinus tachycardia, QTc prolongation, cardiotoxicity, tremors, hallucination, agitation,
seizures and status epilepticus.
When searching for other bupropion overdose cases with necessity for VA-ECMO,
only 3 other cases were identified.5,6 In all cases VA-ECMO showed
to be highly effective in the treatment and support of patients
with severe cardiogenic shock due to bupropion poisoning.
Some studies have reported that, when compared to conventional treatment,
the use of VA-ECMO enhances the survival rate in patients with cardiovascular
failure due to poisoning.
Emerg Med Open J. 2021; 7(1): 1-6. doi: 10.17140/EMOJ-7-158