Cardiogenic Shock secondary to Amlodipine overdose rescued by VA ECMO

Abstract

Ingestion of amlodipine beyond the recommended dose can have adverse effects including refractory symptomatic bradycardia, hypotension, shock, pulmonary edema, and circulatory collapse. Management of amlodipine toxicity is challenging but primarily involves supportive management with intravenous fluid hydration, vasopressor support, calcium chloride and insulin infusion. However, in the past few years cases extracorporeal membrane oxygenation (ECMO) has been successfully utilized as a rescue therapy for acute amlodipine overdose when all conventional treatment measures have failed. Veno-arterial ECMO allows for gaseous exchange, hemodynamic support, and vital organ perfusion until hemodynamically stability is achieved. Here we report a case of a 62-year-old male with 800 mg amlodipine toxicity presenting with refractory hypotension, bradycardia, and severe metabolic acidosis that was successfully managed and rescued with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). With this case we would like to emphasize on utilizing ECMO as a viable option to provide relatively safe, and lifesaving therapeutic option for individuals with refractory shock in lethal drug poisoning