Successful extracorporeal cardiopulmonary resuscitation in a refractory out-of-hospital cardiac arrest after ethylene glycol poisoning

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.

Ethylene glycol; Out-of-hospital cardiac arrest; Extracorporeal cardiopulmonary resuscitation

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