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Case report: transcaval impella placement in a patient with acute lv dysfunction from ethylene glycol toxicity


Journal of Anesthesia & Critical Care: Open Access
Prashanth Singanallur MD,  Nilesh Goswami MD, Govind Pandompatam MD, Muhammad Kashif Qaseem MD

Abstract

Introduction: Ethylene glycol is a toxic alcohol commonly found in antifreeze, or other
household and industrial agents. Patients usually survive ethylene glycol toxicity when
promptly treated but delay in care can cause significant morbidity and mortality. Significant
metabolic acidosis can lead to multisystem organ dysfunction including Left ventricular
dysfunction which can pose a unique challenge.
Case report: The patient is a young female who presented with acute encephalopathy,
intraventricular hemorrhage (IVH), severe metabolic acidosis, and severe left ventricular
dysfunction following acute ethylene glycol toxicity. A diagnosis was quickly made due to
presence of calcium oxalate crystals in the urine. The patient received timely interventions
with Fomepizole and kidney replacement therapy (KRT), which failed to reverse her
severe shock. The patient required mechanical circulatory support (MCS) in the form of
Transcaval peripheral ventricular assist device (pVAD).
Conclusion: This case showed the use of the transcaval approach to place an pVAD in a
young patient suffering from ethylene glycol toxicity and severe left ventricular dysfunction.
Although it remains an uncommon approach, it can be used when more traditional access
points have failed, and the patient requires MCS.

Keywords

Ethylene glycol, Impella, percutaneous ventricular assist device

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