Integrated Use of Extracorporeal Membrane Oxygenation and Molecular Adsorbent Recirculating System for Refractory Cardiotoxic Ingestion: A Single-Center Case Series.
Tori Ehrhardt, C Christopher Zalesky, Aaron Shepherd et al.
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Case in brief
Five consecutive patients with severe calcium-channel blocker or beta-adrenergic antagonist ingestions developed profound hypotension and respiratory failure despite standard therapies. Through a regionally triggered transfer pathway, all received molecular adsorbent recirculating system (MARS) therapy for drug clearance and vasoplegia management; two also required venovenous extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia. Four patients survived to discharge, while one died from profound myocardial poisoning. Reported complications included continuous renal replacement therapy filter clotting and catheter-associated thrombosis.
What made this case unusual
The management combined MARS with venovenous ECMO for refractory hypoxemia in two patients, within a coordinated regional transfer pathway for severe cardiotoxic ingestion.
Diagnostic / clinical pearl
In severe cardiotoxic ingestion with persistent shock and respiratory failure, this case series describes MARS use for drug clearance and vasoplegia, with venovenous ECMO used when hypoxemia remained refractory.
Why it matters
The authors report that a coordinated regional protocol enabling early access to ECMO and MARS was feasible for massive cardiotoxic ingestions.