Clinical characteristics of patients with cardiac arrest induced by pesticide poisoning: Analysis of 15 cases

Abstract

Introduction and objective: Pesticide poisoning induced cardiac arrest (PPICA) has rarely been reported before, and can easily be overlooked by physicians. The aim of the study was to investigate the clinical characteristics of PPICA patients.

Methods: This was a single-center, retrospective analysis in the emergency intensive care unit (EICU) at tertiary medical facility, from January 2015 to December 2018.

Results: A total of 15 patients with PPICA in EICU were included, of which nine were females, where suicide was the only cause of poisoning. Thirteen were in-hospital cases and only three cases showed an initial shockable rhythm. On admission, patients' median acute physiology and chronic health evaluation II score was 20 (12, 21) and median sequential organ failure assessment score was 7 (4, 10). All cases required invasive mechanical ventilation and vasopressors therapy. Seven patients received blood purification therapy. The primary toxic agent was organophosphorus pesticide (OP) and all OP cases (8/15) received pralidoxime and atropine therapy. Thirteen patients received gastric decontamination. The primary complications were cardiogenic shock (10/15) and acute kidney injury (3/15). Seven patients survived at discharge. Of these, three made a full recovery without neurological sequelae.

Conclusions: Cardiac arrest has rarely been reported in pesticide poisoning before, and can easily be overlooked. Physicians therefore should pay attention to specific therapy and best supportive treatment, which could be critical to improve the disease outcomes.

Keywords: Cardiac arrest; Envenenamiento por pesticidas; Paro cardíaco; Pesticide poisoning; Prognosis; Pronóstico.