• Marco Witkowski, Hans-Christian Mochmann, Ursula Rauch, Wulf Knie, Ulf Landmesser, and Carsten Skurk.
• Department of Cardiology, Charité-Universitätsmedizin Campus Benjamin Franklin, Berlin, Germany.
• Crit. Care Med. 2016 Apr 1; 44 (4): e227-30.

ObjectiveTo report a case of intra-arterial amiodarone injection in a hemodynamically unstable patient leading to acute vessel occlusion and a subsequent compartment syndrome.DesignCase report.SettingPrehospital setting, emergency department and ICU of a university hospital.PatientA 58-year-old woman presenting with a ventricular tachycardia of 190 beats/min was administered amiodarone through an accidently placed arterial access in the left cubital fossa. Quickly, the woman developed clinical signs of an acute arterial occlusion.InterventionsImmediate left brachial artery angiography with subsequent thrombectomy was performed.Measurements And Main ResultsA thrombotic occlusion at the injection side was found, which was immediately recanalized by thrombus aspiration. In addition to anticoagulation and an adenosine diphosphate-antagonist an adjunct therapy with vasodilators and gpIIb/IIIa inhibitors was given and repetitive duplex sonography confirmed arterial flow. However, despite restoration of blood flow the patient developed a severe compartment syndrome of the arm and had to receive multistep surgical interventions.ConclusionsThis is the first report of an acute thrombotic vessel occlusion leading to a compartment syndrome upon accidental intra-arterial injection of amiodarone in an emergency setting. In the hemodynamically unstable patient healthcare providers should be aware of arterial miscanulation and its consequences. Upon intra-arterial injection, a direct antithrombotic and vasodilative therapy should be administered via the initially misplaced arterial access, which may include a gpIIb/IIIa inhibitor.

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