Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2024; 12(21): 4842-4852
Published online Jul 26, 2024. doi: 10.12998/wjcc.v12.i21.4842
Treatment of a patient with aconitine poisoning using veno-arterial membrane oxygenation: A case report
Yu-Yao Bian, Jin Hou, Sudha Khakurel
Yu-Yao Bian, Department of Emergency Medicine, Hebei Petro China Central Hospital, Langfang 065000, Hebei Province, China
Jin Hou, Department of Internal Medicine, Langfang Health Vocational College, Langfang 065000, Hebei Province, China
Sudha Khakurel, Dallas Campus, UT Health Houston School of Public Health, Dallas, TX 75201, United States
Author contributions: Bian YY contributed to conceptualization, data curation, validation, writing original draft, writing review and editing; Hou J contributed to data curation, data analysis, validation, writing review and editing; Khakurel S contributed to data curation, data analysis, validation, writing review and editing, and English polishing; All authors have read and approved the final version to be published.
Informed consent statement: The case has been consented and authorized by the patient and his wife.
Conflict-of-interest statement: This article has not been sponsored by any pharmaceutical or medical device companies, and there are no conflicts of interest among the authors.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Yao Bian, Doctor, MM, Doctor, Professor, Department of Emergency Medicine, Hebei Petro China Central Hospital, No. 51 Xinkai Road, Guangyang District, Langfang 065000, Hebei Province, China. 55029360@qq.com
Received: April 22, 2024
Revised: May 23, 2024
Accepted: June 12, 2024
Published online: July 26, 2024
Processing time: 69 Days and 8.7 Hours
Abstract
BACKGROUND

Aconitine poisoning is highly prone to causing malignant arrhythmias. The elimination of aconitine from the body takes a considerable amount of time, and during this period, patients are at a significant risk of death due to malignant arrhythmias associated with aconitine poisoning.

CASE SUMMARY

A 30-year-old male patient was admitted due to accidental ingestion of aconitine-containing drugs. Upon arrival at the emergency department, the patient intermittently experienced malignant arrhythmias including ventricular tachycardia, ventricular fibrillation, ventricular premature beats, and cardiac arrest. Emergency interventions such as cardiopulmonary resuscitation and defibrillation were promptly administered. Additionally, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy was initiated. Successful resuscitation was achieved before ECMO placement, but upon initiation of ECMO, the patient experienced recurrent malignant arrhythmias. ECMO was utilized to maintain hemodynamics and respiration, while continuous blood purification therapy for toxin clearance, mechanical ventilation, and hypothermic brain protection therapy were concurrently administered. On the third day of VA-ECMO support, the patient’s respiratory and hemodynamic status stabilized, with only frequent ventricular premature beats observed on electrocardiographic monitoring, and echocardiography indicated recovery of cardiac contractile function. On the fourth day, a significant reduction in toxin levels was observed, along with stable hemodynamic and respiratory functions. Following a successful pump-controlled retrograde trial occlusion test, ECMO assistance was terminated. The patient gradually improved postoperatively and achieved recovery. He was discharged 11 days later.

CONCLUSION

VA-ECMO can serve as a bridging resuscitation technique for patients with reversible malignant arrhythmias.

Keywords: Poisoning, Arrhythmia, Blood purification, Veno-arterial extracorporeal membrane oxygenation, Resuscitation, Case report

Core Tip: A patient poisoned by aconitine was treated with detoxification therapy under Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support and made a full recovery. VA-ECMO can stabilize the hemodynamics of patients poisoned by drugs, providing a therapeutic opportunity for toxin elimination and the recovery of spontaneous cardiac activity and vital signs. We believe that VA-ECMO is an effective method for treating malignant arrhythmias caused by drug poisoning, which can reduce the risk of patient mortality. VA-ECMO is an effective method for treating malignant arrhythmias caused by drug poisoning.