lutetium-lu-177-dotatate and Heart-Arrest

Peptide receptor radionuclide therapy (PRRT) is an effective treatment for metastatic carcinoid tumours but can precipitate a carcinoid crisis through release of stored bioamines. Cardiac arrest is an uncommon manifestation of carcinoid crisis and has never been reported as a complication of PRRT. We report a case of a 58-year old female who suffered from cardiac arrest following PRRT for metastatic carcinoid tumour. She was successfully resuscitated using intravenous octreotide following 22 min of failure to resuscitate with a standard advanced cardiac life support protocol. Following resuscitation, severe carcinoid heart disease was diagnosed, and the patient subsequently underwent successful surgical valve replacement. Although there is no trial evidence, considering pharmacological rationale and successful outcome in this case, we suggest early administration of intravenous octreotide during resuscitation of patients suffering cardiac arrest post PRRT for carcinoid disease and recommend preventive strategies.

Topics: Antineoplastic Agents, Hormonal; Carcinoid Tumor; Disease Progression; Female; Follow-Up Studies; Heart Arrest; Humans; Intestinal Neoplasms; Middle Aged; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Radiopharmaceuticals; Resuscitation; Treatment Outcome