Accidental Aluminum Phosphide Poisoning of A Family and Role of Impella® Support: A Case Report.

BACKGROUND

Aluminum phosphides (AlPs) are highly effective fumigant pesticides that emit phosphine gas when exposed to moisture. Phosphine gas is highly toxic and exposure can lead to widespread multiorgan failure. Cardiovascular collapse can be rapid and many AlP poisonings are fatal despite aggressive resuscitation measures.

CASE REPORT: We describe a series of ten cases of phosphine gas poisoning due to a single exposure. Five patients had minor symptoms, four died presumably due to rapid cardiovascular collapse, and one survived to hospital discharge after undergoing Impella® support and subsequent extracorporeal membrane oxygenation (ECMO). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Phosphine gas exposure can cause rapid cardiovascular collapse and death despite aggressive resuscitation measures. This appears to be the first documented use of an Impella® device for toxin-induced shock; however, successful recovery utilizing an intra-aortic balloon pump and ECMO has been reported previously. This case highlights the need for early recognition, multidisciplinary coordination, and timely transfer to centers with advanced circulatory support.