Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) successfully stabilized a 62-year-old man with refractory electrical storm following strong acid ingestion, leading to cardiac recovery.
Case Report (n=1)
VA-ECMO may be a viable rescue therapy for refractory electrical storm and cardiogenic shock secondary to severe acid poisoning.
Introduction: Strong acid ingestion can cause catastrophic gastrointestinal and systemic damage. While corrosive injury is expected, development of refractory electrical storm (ES)-a life-threatening arrhythmia is exceedingly rare. Effective management strategies for such toxic cardiac complications remain unclear. Description: A 62-year-old man ingested ~100 mL of industrial descaling agent containing hydrochloric and sulfuric acid. He presented with hematemesis and epigastric pain. Two hours after admission, he developed sudden loss of consciousness and suffered seven episodes of ventricular fibrillation (VF) consistent with electrical storm. Despite antiarrhythmic drugs (amiodarone, lidocaine, esmolol), electrolyte correction, and defibrillation, VF persisted. Labs revealed metabolic acidosis and hypocalcemia. Bedside echocardiography showed left ventricular ejection fraction (EF) of 30%. Due to refractory shock and arrhythmia, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated. The patient stabilized, and vasoactive agents were weaned by day 3. He was decannulated on day 9 with cardiac recovery. Endoscopy revealed corrosive gastritis, diffuse ulceration, and pyloric stenosis, later requiring jejunostomy. He was discharged from ICU after 17 days. Discussion: This is a rare case of acid-induced ES requiring ECMO. The arrhythmia was likely triggered by hypocalcemia, acidosis, and direct myocardial toxicity. VA-ECMO provided circulatory support and a window for metabolic correction and myocardial recovery. This case emphasizes the importance of early recognition, multidisciplinary care, and the potential role of ECMO in managing toxic cardiac complications when conventional therapies fail. Artificial intelligence assistance (ChatGPT, OpenAI) was used in the drafting and English-language editing of this case report. All clinical content and interpretations were verified by the authors.
Luo et al. (Sun,) conducted a case report in Strong acid poisoning presenting with refractory electrical storm (n=1). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was evaluated on Cardiac recovery and survival. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) successfully stabilized a 62-year-old man with refractory electrical storm following strong acid ingestion, leading to cardiac recovery.