Dobutamine/vasopressors

Abstract

Lack of efficacy: case report An 18-year-old woman did not respond to dobutamine and unspecified vasopressors for the treatment of sudden cardiogenic shock. The woman was hospitalised in Belgium due to nausea and vomiting, which had started 1 day prior to admission. Upon admission, multiple clinical features of impending shock were noted. Further analyses also raised suspicions of a fulminant myocarditis; hence, she was shifted to the ICU. She was treated with increased infusion rates of unspecified vasopressors and dobutamine [dosages not stated]; however, in spite of these interventions, she remained in a state of shock, and she further developed acute respiratory failure. Therefore, she was mechanically ventilated, and a percutaneous venoarterial extracorporeal membrane oxygenation (VA‐ECMO) was inserted because of the refractory cardiogenic shock. Further analyses revealed presence of SARS-CoV-2 nucleic acid; hence, she started receiving off-label hydroxychloroquine 400mg BID on day 1, followed by 200mg BID on days 2–5, alongside high doses of methylprednisolone, immune globulin and unspecified antibiotics. She experienced multiple complications during ICU stay; however, her condition gradually improved by the time she was discharged. It was concluded that the sudden cardiogenic shock mimicked a fulminant myocarditis.