Asystole after ear suctioning

Mr AG presented to the emergency department complaining of pruritic ear. Upon examina-tion, the doctor found impacted cerumen in the external auditory meatus. The patient reported that he had been otherwise fit and well, had two myocardial infarctions in the past; no signs and symptoms of heart failure. The patient was on anti-anginals and had been compliant with his medications. He further complained that whenever he tried to clean his ears with cotton wool he felt vertiginous and thus he just wiped the pinna with a wet cloth. The ENT doctor started cleaning with a suction device to clean the deep debris. The pa-tient was compliant and keen on the procedure. After a few seconds into the vacuum suction-ing, the patient was nonresponsive. The doctor put up a crash call. The ECG read asystole and the patient was immediately resuscitated as protocol. The patient required two cycles of resuscitation after which he woke up. He was forwarded to the cardiac unit for an exten-sive workup. Upon further investigation, the patient had had a few milder episodes similar to the ones described. He had been diagnosed with diabetes recently, but he was able to maintain his blood glucose with diet and met-formin. The patient was discharged two days later with further plans for angiography.