A case of yew leaf intoxication and cardiogenic shock managed on extracorporeal membrane oxygenation

Yew leaf intoxication – a rare yet potentially fatal condition caused by ingestion of Taxus baccata leaves – can lead to severe cardiotoxicity, manifesting as cardiac arrhythmias and cardiogenic shock. This report presents a case of a patient who ingested approximately 30 grams of yew leaves in an attempted overdose. The patient was admitted to the emergency department in cardiogenic shock and experienced cardiac arrest upon arrival. They were successfully resuscitated in the emergency department. Given their haemodynamic instability, they were transferred to a quaternary centre and treated with veno-arterial extracorporeal membrane oxygenation, along with other supportive measures including gastroscopy, intralipid, digoxin immune fab (antidote for digoxin toxicity), insulin, amiodarone, and adrenaline infusions. The patient showed significant improvement through multidisciplinary interventions, leading to successful weaning off extracorporeal membrane oxygenation and subsequent decannulation. They were then repatriated to the initial admitting hospital for further recovery. This case underscores the importance of early recognition and intervention in yew leaf poisoning, highlighting the critical role of veno-arterial extracorporeal membrane oxygenation in managing severe cardiogenic shock secondary to yew leaf toxicity. A review of existing literature reveals limited reported cases of veno-arterial extracorporeal membrane oxygenation use in yew leaf poisoning, underscoring the rarity of such interventions and the need for heightened clinical awareness and preparedness for life-saving treatments.