Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection
Abstract Anaphylactic shock to contrast media can progress to cardiac arrest despite appropriate treatment. During anaphylactic shock to contrast media, rapid vasodilation and a massive fluid shift can occur. Here we report a patient who developed cardiac arrest induced by anaphylactic shock to iodi...
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Elsevier
2020-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12166 |
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| author | Daiki Kaito Koichiro Homma Junichi Sasaki |
| author_facet | Daiki Kaito Koichiro Homma Junichi Sasaki |
| author_sort | Daiki Kaito |
| collection | DOAJ |
| description | Abstract Anaphylactic shock to contrast media can progress to cardiac arrest despite appropriate treatment. During anaphylactic shock to contrast media, rapid vasodilation and a massive fluid shift can occur. Here we report a patient who developed cardiac arrest induced by anaphylactic shock to iodinated contrast medium and exhibited rapid collapse of the inferior vena cava (IVC) on enhanced abdominal computed tomography (CT) images. The patient underwent postsurgical unenhanced and contrast‐enhanced abdominal CT follow‐up of cecum cancer. She had neither allergy nor medical history except for the cancer. She did not complain of any symptoms immediately after completion of the CT. However, she developed anaphylactic shock and pulseless electrical activity cardiac arrest only 2 minutes after finishing the CT despite appropriate treatment. Emergency physicians successfully treated the patient using advanced life support and targeted temperature management. She recovered with good overall and cerebral performance (Overall Performance Category (OPC) 1 and Cerebral Performance Category (CPC) 1). On the contrast‐enhanced CT images, she exhibited rapid collapse of the IVC, although it was normal on the unenhanced CT images. The collapsed IVC is a good indicator of hypovolemia in patients with trauma. In this case, we considered that rapid vasodilation and a massive volume shift might have caused the collapsed IVC. This finding suggests the importance of aggressive volume resuscitation as well as epinephrine injection in patients with anaphylactic shock to contrast media. Furthermore, this finding occurred before the onset of clinical symptoms, and there is a possibility that it could be used as an indicator of anaphylactic shock to contrast media. |
| format | Article |
| id | doaj-art-8626047ad2d244a7b0acd75d3b1abcb9 |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
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| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-8626047ad2d244a7b0acd75d3b1abcb92025-08-20T02:11:18ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522020-08-011437938210.1002/emp2.12166Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injectionDaiki Kaito0Koichiro Homma1Junichi Sasaki2Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo JapanDepartment of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo JapanDepartment of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo JapanAbstract Anaphylactic shock to contrast media can progress to cardiac arrest despite appropriate treatment. During anaphylactic shock to contrast media, rapid vasodilation and a massive fluid shift can occur. Here we report a patient who developed cardiac arrest induced by anaphylactic shock to iodinated contrast medium and exhibited rapid collapse of the inferior vena cava (IVC) on enhanced abdominal computed tomography (CT) images. The patient underwent postsurgical unenhanced and contrast‐enhanced abdominal CT follow‐up of cecum cancer. She had neither allergy nor medical history except for the cancer. She did not complain of any symptoms immediately after completion of the CT. However, she developed anaphylactic shock and pulseless electrical activity cardiac arrest only 2 minutes after finishing the CT despite appropriate treatment. Emergency physicians successfully treated the patient using advanced life support and targeted temperature management. She recovered with good overall and cerebral performance (Overall Performance Category (OPC) 1 and Cerebral Performance Category (CPC) 1). On the contrast‐enhanced CT images, she exhibited rapid collapse of the IVC, although it was normal on the unenhanced CT images. The collapsed IVC is a good indicator of hypovolemia in patients with trauma. In this case, we considered that rapid vasodilation and a massive volume shift might have caused the collapsed IVC. This finding suggests the importance of aggressive volume resuscitation as well as epinephrine injection in patients with anaphylactic shock to contrast media. Furthermore, this finding occurred before the onset of clinical symptoms, and there is a possibility that it could be used as an indicator of anaphylactic shock to contrast media.https://doi.org/10.1002/emp2.12166anaphylaxisdistributive shockcontrast mediainferior vena cavaresuscitationcomputed tomography |
| spellingShingle | Daiki Kaito Koichiro Homma Junichi Sasaki Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection Journal of the American College of Emergency Physicians Open anaphylaxis distributive shock contrast media inferior vena cava resuscitation computed tomography |
| title | Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection |
| title_full | Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection |
| title_fullStr | Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection |
| title_full_unstemmed | Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection |
| title_short | Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection |
| title_sort | rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection |
| topic | anaphylaxis distributive shock contrast media inferior vena cava resuscitation computed tomography |
| url | https://doi.org/10.1002/emp2.12166 |
| work_keys_str_mv | AT daikikaito rapidcollapseoftheinferiorvenacavainapatientwithcardiacarrestinducedbyanaphylacticshockafteriodinatedcontrastmediuminjection AT koichirohomma rapidcollapseoftheinferiorvenacavainapatientwithcardiacarrestinducedbyanaphylacticshockafteriodinatedcontrastmediuminjection AT junichisasaki rapidcollapseoftheinferiorvenacavainapatientwithcardiacarrestinducedbyanaphylacticshockafteriodinatedcontrastmediuminjection |