Extracorporeal life support in a case of acute carbamazepine poisoning with life-threatening refractory myocardial failure

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Abstract
To report the efficacy of extracorporeal life support (ECLS) in acute carbamazepine poisoning with sustained refractory myocardial failure and a high degree of conductance disturbances. Case report from the toxicological and medical intensive care unit in a university hospital. A 26-year-old man with severe myocardial failure unresponsive to 1.7 μg kg−1 min−1 epinephrine and 1.9 μg kg−1 min−1 norepinephrine (SvO2, 17.8% and cardiac index, 0.8 l min−1 m−2) following a suicidal ingestion of 32 g slow-release carbamazepine. ECLS (Jostra-Maquet centrifugal pump (Rotaflow) connected to a hollow-fiber membrane oxygenator). ECLS device allowed inotropic drug weaning while maintaining end-organ function and supported the patient until myocardial recovery. The plasma carbamazepine level was 224 μmol/l on admission and peaked at 338 μmol/l 101 h after admission with a prolonged gastrointestinal absorption phase despite multiple doses of activated charcoal. The patient survived and was successfully explanted on day 6. An extensive and regressive thrombosis of the inferior vena cava was noted. Cardiac function totally recovered and at 2-year follow-up. There were no significant sequelae. We report a case of life-threatening myocardial failure with conductance disturbances secondary to an acute carbamazepine poisoning, demonstrating the efficacy of ECLS to assist recovery.