Real-world experience of veno-arterial extracorporeal membrane oxygenation in severe aluminium phosphide poisoning

Mitochondrial toxicity caused by phosphine released from aluminium phosphide in the presence of moisture leads to haemodynamic collapse, and the mortality from aluminium phosphide ingestion is high. In anecdotal studies, veno-arterial extracorporeal membrane oxygenation appears to reduce mortality. A retrospective, single-centre study was conducted of patients with aluminium phosphide poisoning managed between 2019 and 2023. Clinical data were retrieved and analysed. Additionally, outcomes of patients who declined hospital admission were traced and reviewed. Of the 182 patients admitted with aluminium phosphide poisoning, 78 (42.9%) underwent veno-arterial extracorporeal-membrane-oxygenation, with a mean age of 34.4 ± 11.7 years. At presentation, 60 patients (76.9%) exhibited multiple organ dysfunction, and 74 (94.9%) showed electrocardiographic abnormalities. Veno-arterial extracorporeal membrane oxygenation was initiated in the emergency department for 68 patients (87.2%) and during cardiopulmonary resuscitation in eight patients (10.3%). Concurrent kidney replacement therapy was administered to 53 patients (67.9%). The median time from emergency department arrival to veno-arterial extracorporeal membrane oxygenation initiation was 1 h (IQR: 0.5-2.0 h), with a significant (P = 0.02) delay observed among survivors. The median duration of extracorporeal membrane oxygenation support was 48.0 h (IQR: 36.0-68.0 h), and the median intensive care unit stay was 6 days (IQR: 4-9 days). The overall survival with veno-arterial extracorporeal membrane oxygenation was 67.9% (n = 53), while 25 patients (32.1%) died despite this support. Among the 17 traceable patients who declined admission, the mortality was 100%. Complications related to extracorporeal membrane oxygenation occurred in 63 patients (80.8%), with 15 (19.2%) experiencing severe adverse events. Our study has some limitations. It was a single-centre retrospective study, which limits the generalizability of the findings, and our data are prone to selection bias. A retrospective study of 78 patients with aluminium phosphide poisoning who underwent veno-arterial extracorporeal membrane oxygenation was conducted in a single centre, and the overall survival was 67.9%. Veno-arterial extracorporeal membrane oxygenation offers temporary circulatory support during reversible myocardial depression with a high risk of complications. Further prospective, multicentre studies are warranted to refine indications, evaluate cost-effectiveness and assess long-term outcomes in aluminium phosphide poisoning.