Successful Rescue of Malignant Cardiac Dysrhythmia and Cardiogenic Shock Induced by Severe Aconitine Poisoning: The Pivotal Role of Early Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Recovery.

BACKGROUND: Aconitine alkaloids, present in herbs like Shengchuanwu and Shengcaowu, are highly cardiotoxic. We describe a rare case of life-threatening aconitine poisoning following the intentional oral ingestion of ``Fufang Jingjie for Fumigation and Washing''-a topical herbal preparation-and highlight the pivotal role of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as rescue therapy.

CASE REPORT: A 65-year-old female presented with cardiogenic shock and refractory ventricular tachycardia after orally ingesting 10 g of the herbal agent. The concentration of aconitine in her serum was critically elevated at 108 ng/mL. Despite initial aggressive management including antidysrhythmic drugs (lidocaine, amiodarone), vasopressors, and hemoperfusion, her hemodynamic status worsened rapidly. As a salvage therapy, VA-ECMO was initiated 6.5 h post-exposure. This intervention promptly stabilized her hemodynamics, and sinus rhythm was restored 6 h later. The patient was weaned from ECMO after 24 h and discharged without sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Acute aconitine poisoning can result in extremely high serum toxin levels and rapidly progressive, treatment-resistant cardiogenic shock. When conventional therapies fail, early and prompt initiation of VA-ECMO serves as a crucial ``time-buying'' bridge, sustaining cardiopulmonary function and allowing for endogenous toxin clearance, thereby facilitating survival and excellent recovery even in the most severe cases.