• 
• 

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
"Anesthetics, Local"[MeSH] AND "Heart Arrest"[MeSH] AND "Lipid"[MeSH] Limit to human.

Search Outcome

Five papers of which two were case reports and three were irrelevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
R J Litz 2006 Germany	84 year ol female	case report	Return of spontaneous circulation after cardiac arrest	Initial resuscitation from cardiac arrest unsuccessful
MA Rosenblatt 2006 USA	58 year old man	case report	Return of spontaneous circulation of cardiac arrest	Initial resuscitation from cardiac arrest unsuccessful

Comment(s)

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.

Clinical Bottom Line

It is reasonable to give lipid emulsion in cardiac arrest due to lipid toxicity.

References

1. RJ Litz, M Popp, SN Stehr, T Koch Successful resuscitation of a patient with ropivicaine-induced asystole after axillary plexus block Anaesthesia 2006, 61, pages 800-801
2. 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 Anesthesiology 2006, 105, pages 217-218