Case Report

Central ECMO cannulation for severe dihydropyridine calcium channel blocker overdose

¹ Division of Pediatric Cardiology Section of Cardiac Critical Care. University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
² Department of Cardiovascular Perfusion Children’s of Alabama, Birmingham, AL, USA
³ ECMO Clinical Coordinator Children’s of Alabama, Birmingham, AL, USA
⁴ Department of Pediatric Emergency Medicine. University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
⁵ Department of Pediatric Critical Care. University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

^* Corresponding author: jcardenasfimbres@yahoo.com

Received: 14 August 2023
Accepted: 5 October 2023

Abstract

Calcium channel blocker (CCB) toxicity carries a high mortality and is the sixth most fatal drug class reported to US poison centers. Amlodipine overdose is characterized by a life-threatening arterial vasodilation that compromises organ perfusion. The management of CCB intoxication is focused on maintaining adequate organ perfusion. In cases refractory to medical therapies, hemodynamic support with extracorporeal membrane oxygenation (ECMO) is warranted necessitating higher flows than usual to compensate for the vasodilation and requiring central cannulation. We present a case of a 12-year-old with severe dihydropyridine CCB ingestion, refractory to medical management and successfully treated with central ECMO cannulation. The patient was discharged home with no significant disability. Central ECMO cannulation may be helpful to facilitate adequate flows in vasodilatory shock such as CCB overdose.