Successful extracorporeal cardiopulmonary resuscitation in a refractory out-of-hospital cardiac arrest after ethylene glycol poisoning
Signa Vitae · 2024-01-01 · Case report
Abstract
Here, we report the first case of successful extracorporeal cardiopulmonary resuscitation (eCPR) in a patient with an out-of-hospital cardiac arrest following the ingestion of a lethal dose of ethylene glycol (EG). A 49-year-old man was found unconscious for an unknown period of time after suspected ethylene glycol ingestion. Upon arrival of the Emergency Medical Service (EMS), the patient was found to have a Glasgow Coma Score of 3, bilateral non-reactive mydriasis, and hypoventilation. Despite the urgent orotracheal intubation, the patient developed cardiac arrest immediately thereafter. After 8 minutes of conventional CPR, the regional ECMO (extracorporeal membrane oxygenation) center was contacted. The patient was transferred under mechanical CPR to an ECMO center where veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated 59 minutes after the cardiac arrest. Laboratory tests confirmed EG intoxication with a plasmatic EG level of 1474 mg/L, greatly exceeding reported lethal values. A left stellate ganglion blockade was performed because of refractory ventricular fibrillation, and the return of spontaneous circulation was achieved 149 minutes after the cardiac arrest. As a result of direct organ toxicity, the patient developed anuric acute kidney injury and multifocal brain lesions revealed by nuclear magnetic resonance imaging. In addition to the VA-ECMO, the therapeutic protocol included hemodialysis, intravenous ethanol and fomepizole. This multimodal treatment eventually led to the patient’s survival with near complete recovery.
Abstract © the authors or publisher, via OpenAlex. Reuse and removal
Tags
ECMO & mechanical circulatory support · Endotracheal intubation · Mechanical CPR · Mortality & survival · Quality of life & function
Related articles
- The FaciLItated hospital-based ECPR via Helicopter Transport (FLIGHT-to-ECPR) study. (Resuscitation, 2026)
- Prehospital initiation of extracorporeal life support for refractory out-of-hospital cardiac arrest-results of a prospective observational study. (Crit Care, 2026)
- Implementation of a regional extracorporeal membrane oxygenation program for out-of-hospital cardiac arrest: results of the prospective observational study. (Resusc Plus, 2026)
- A randomized trial of expedited intra-arrest transfer versus more extended on-scene resuscitation for refractory out of hospital cardiac arrest: Rationale and design of the EVIDENCE trial. (Am Heart J, 2024)
- Mechanical chest compression and extracorporeal life support for out-of-hospital cardiac arrest. A 30-month observational study in the metropolitan area of Milan, Italy. (Resuscitation, 2023)
- Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. (JAMA, 2022)