Cardiac arrest in intensive care unit: case report and future recommendations

Initiation of hemofiltration in a patient in septic shock can cause hemodynamic compromise potentially leading to cardiac arrest. We propose that the standard '4Hs and 4Ts' approach to the differential diagnosis of a cardiac arrest should be supplemented in critically ill patients with anaphylaxis and human and technical errors involving drug administration [the 5th H and T]. To illustrate the point, we report a case where norepinephrine infused through a central venous catheter [CVC] was being removed by the central venovenous hemofiltration [CVH] catheter causing the hemodynamic instability. CVVH has this potential of interfering with the systemic availability of drugs infused via a closely located CVC