Successful Reversal of Severe Amlodipine and Propranolol Poisoning with Veno-Arterial Extracorporeal Membrane Oxygenation Combined with Blood Purification: A Case Report of Prolonged Cardiac Arrest.

BACKGROUND

Combined calcium channel blocker (CCB) and β-blocker poisoning is highly lethal due to synergistic negative inotropy, conduction blockade, and vasodilation, often leading to refractory cardiogenic shock or cardiac arrest.

CASE REPORT: An 18-year-old male presented after ingesting massive doses of nifedipine (5 mg × 200 tablets) and propranolol (10 mg × 300 tablets). Despite approximately 18 h of persistent cardiac arrest, early initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO), followed sequentially by hemoperfusion and plasma exchange, restored cardiac rhythm. ECMO was successfully weaned, and the patient recovered with intact neurological function. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates that even in prolonged cardiac arrest from ultra-high-dose CCB/β-blocker poisoning, aggressive support with VA-ECMO combined with toxin-removal techniques can achieve survival with good neurological outcome. It highlights a potentially lifesaving approach for similar severe poisoning scenarios.