Vancomycin Induced Cardiac Arrest: A Case Report

Sharad Khakurel; Sangam Rawal


J Med Case Reports. 2021;15(77) 

In This Article

Case Presentation

We recount of a 9-year-old Asian girl diagnosed with Ewing's sarcoma of left distal tibia. She had received six cycles of chemotherapy that had reduced the size of periosteal lesion compared to few months back. So she was planned for wide resection of the tumor along with reconstruction of her leg. To prevent the risks of implant associated infection, it was decided that the bone cement used during surgery would be impregnated with vancomycin. Following a routine pre-anesthetic assessment, she was cleared for surgery.

A night before the surgery at around 10 pm, an order of prophylactic intravenous vancomycin 500 milligram (mg) in 100 milliliters (mls) of 0.9% normal saline (NS) over 1 hour was carried out in the orthopedic ward. However the drug was accidently infused in about 5 minutes. Soon the patient was restless, complained of epigastric discomfort along with suffocation and feeling of tightness in her chest and neck. There was visible flushing of her face. Within a matter of seconds, she was dyspneic with oxygen saturation falling to 40% along with drop in blood pressure to 40/20 millimeters of mercury (mm Hg). Suddenly her respiration ceased and carotid pulse was impalpable. Immediately chest compression was initiated along with bag and mask ventilation. 0.9% NS was infused rapidly. The patient's trachea was intubated and ventilation continued. There was return of spontaneous circulation (ROSC) after a minute of chest compressions. Following ROSC, her heart rate was 140 beats per minute in sinus rhythm, oxygen saturation of 99 % with oxygen and blood pressure of 120/90 mm of Hg with Glasgow coma scale (GCS) of E4M5Vt. She was given an injection of pheniramine 10 mg and hydrocortisone 50 mg intravenously. On auscultation of chest, there was decreased air entry bilaterally along with expiratory wheeze that resolved with salbutamol nebulization. She was shifted to Intensive care unit (ICU) where respiration was controlled by mechanical ventilation overnight under sedation. A chest x-ray done was normal. Overnight there were no issues to be addressed and was planned for gradual tapering of sedation. In the morning, she gradually gained full consciousness with normal arterial blood gas analysis and blood reports. The patient's trachea was extubated following a successful spontaneous breathing trial with T-piece. She was discharged from ICU in the evening with resumption of normal feeding and discharged from the hospital a day after.

The child was admitted again three weeks later and underwent the contemplated procedure uneventfully.