Serial Serum Nicotine Concentration During VA-ECMO for Nicotine-Induced Cardiac Arrest: A Case Report.

BACKGROUND

Acute nicotine intoxication can cause cardiac arrest. We report a case of cardiac arrest managed with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) alongside serial serum nicotine monitoring.

CASE PRESENTATION: A 36-year-old woman collapsed after ingesting an unknown amount of liquid nicotine, up to 20 g. Emergency medical services found her in cardiac arrest with pulseless electrical activity (PEA). On arrival, she remained in cardiac arrest with PEA/asystole and severe acidosis, and VA-ECMO was established 82 min after ingestion. Cardiac function gradually improved, and VA-ECMO was discontinued on Day 3. However, she died on Day 28 from post-cardiac arrest brain injury. Liquid chromatography-mass spectrometry (LC/MS) revealed an admission serum nicotine concentration of 6.44 μg/mL, declining to 0.057 μg/mL within 18 h. This decline paralleled hemodynamic recovery.

CONCLUSION

Although neurological outcome was unfavorable, VA-ECMO may provide temporary circulatory support during the toxic phase of massive nicotine intoxication.