Successful Rescue of Malignant Cardiac Arrhythmia and Cardiogenic Shock Induced by Severe Aconitine Poisoning: The Pivotal Role of Early VA-ECMO as a Bridge to Recovery

Background Aconitine alkaloids, present in herbs like Shengchuanwu and Shengcaowu , are highly cardiotoxic. We describe a rare case of life-threatening aconitine poisoning following the intentional oral ingestion of "Fufang Jingjie for Fumigation and Washing"—a topical herbal preparation—and highlight the pivotal role of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as rescue therapy. Case report A 65-year-old female presented with cardiogenic shock and refractory ventricular tachycardia after orally ingesting 10 g of the herbal agent. The concentration of aconitine in her serum was critically elevated at 108 ng/mL. Despite initial aggressive management including antiarrhythmic drugs (lidocaine, amiodarone), vasopressors, and hemoperfusion, her hemodynamic status worsened rapidly. As a salvage therapy, VA-ECMO was initiated 6.5 hours post-exposure. This intervention promptly stabilized her hemodynamics, and sinus rhythm was restored 6 hours later. The patient was weaned from ECMO after 24 hours and discharged without sequelae. Why Should an Emergency Physician Be Aware of This Acute aconitine poisoning can result in extremely high serum toxin levels and rapidly progressive, treatment-resistant cardiogenic shock. When conventional therapies fail, early and prompt initiation of VA-ECMO serves as a crucial "time-buying" bridge, sustaining cardiopulmonary function and allowing for endogenous toxin clearance, thereby facilitating survival and excellent recovery even in the most severe cases.