Beyond vasopressor support: VA-ECMO for refractory calcium channel blocker overdose
J-H Cheon1, M Miller1, D Thomson1
1Division of Critical Care, Department of Anaesthesia and Post-Operative Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|December 11, 2025
Summary
Calcium channel blocker overdose can cause refractory shock. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) served as a critical rescue therapy for a patient unresponsive to standard treatments, enabling recovery.
Area of Science:
- Toxicology
- Cardiology
- Critical Care Medicine
Background:
- Calcium channel blocker (CCB) overdose presents a severe toxicological emergency.
- It is characterized by vasoplegia and potential multiorgan failure.
- Refractory shock can occur despite conventional treatments like insulin and vasopressors.
Purpose of the Study:
- To report a case of severe CCB toxicity with refractory shock.
- To highlight the potential role of VA-ECMO as a rescue therapy.
Main Methods:
- A case report of a 15-year-old male with polypharmacy ingestion.
- Management included high-dose insulin euglycemic therapy, calcium, vasopressors, and ultimately VA-ECMO.
- Patient monitoring in the intensive care unit (ICU).
Main Results:
- The patient experienced refractory shock despite maximal conventional therapy.
- Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated 48 hours post-ingestion.
- Successful decannulation after 72 hours on VA-ECMO and discharge on day 7.
Conclusions:
- VA-ECMO can be a life-saving rescue intervention for severe CCB toxicity.
- It offers a viable option when conventional therapies are ineffective.
- Early consideration of advanced mechanical support may improve outcomes.
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