Possible role of ECMO in multiorgan failure and prolonged CPR: Aluminum Phosphide poisoning

Abstract

Introduction: Aluminum phosphide (ALP) is one of the most common causes of poisoning. Also, it is commonly used to attempt suicide. Extracorporeal Membrane Oxygenation (ECMO) is a therapeutic method that supports the function of the heart and lungs, giving body enough time for detoxification and organ function improvement; therefore, management of the problem using ECMO is critical in these patients and increases the survival chance. Moreover, the impact of COVID-19 on the treatment course during the COVID-19 pandemic and the patients' involvement and contact with the virus is a critical issue with unknown consequences. Case presentation: The patient was an 18-year-old girl who was hospitalized due to the poisoning aluminum phosphate. The ECMO was connected to the patient during CPR. Then, the patient was transported to a specialized healthcare facility. At the time of arrival, the EF (Ejection Fraction) was less than 5%. During the course of poisoning, the patient developed ARDS, fulminant hepatitis, massive gastrointestinal and vaginal bleeding, and septicemia. The ECMO was weaned on day 5 when the EF was reported 55%. In the following, the general and pulmonary conditions of the patient exacerbated when she was suspected of having COVID-19. The necessary therapeutic measures were done and finally, the patient was discharged after 45 days. Conclusion: ECMO is a useful therapeutic procedure in ALP poisoned patients. In case of careful management, it can be used in multiple organ involvement and prolonged PCR. Considering the COVID-19 pandemic, it is very important to notice the chance of COVID-19 infection in ICU during treatment.