Successful Use of Venoarterial Extracorporeal Membrane Oxygenation in Acute Drug Intoxication: Three Cases From a Single Japanese Center

The indications for extracorporeal membrane oxygenation (ECMO) have broadened in clinical practice, and its use in circulatory failure caused by acute drug intoxication has become more frequent. We reviewed three cases of venoarterial (VA) ECMO use for intoxication at our hospital. Three cases (aged 60-69 years) developed refractory shock following intentional overdose, including calcium channel blockers. Despite maximal pharmacologic support, all exhibited progressive hemodynamic deterioration and elevated serum lactate levels (max 8.0-20.0 mmol/L). VA ECMO was initiated on the day of admission in each case. Hemodynamic stability was restored, and ECMO was discontinued within 4 to 6 days. All patients survived hospital discharge without major ECMO-related complications. These cases highlight the potential benefit of the timely initiation of VA ECMO in selected intoxicated patients with drug-induced cardiogenic shock. Comparison with other clinical experiences suggests better outcomes when ECMO is implemented before cardiac arrest. Lactate levels at the time of ECMO initiation may serve as a prognostic indicator. The timely initiation of VA ECMO may be life-saving in patients with acute drug intoxication and refractory cardiogenic shock. Careful patient selection, guided by toxin type and pre-ECMO lactate trends, is essential to optimize outcomes.