A Case of Carbamazepine Intoxication Saved by Veno-Arterial Extracorporeal Membrane Oxygenation

Abstract

VA-ECMO (veno-arterial extracorporeal membrane oxygenation) is mostly indicated for cardiogenic shock caused by myocardial infarction or other causes. However, it is also indicated for shocks caused by other factors and cardiovascular diseases. In fact, VA-ECMO may be very useful as an adjunctive treatment for drug-induced cardiogenic shock until the drug effect wears off. We have experienced a case of bradyarrhythmia and cardiopulmonary arrest due to high-dose carbamazepine ingestion, and VA-ECMO was introduced to save the patient’s life. The patient was a female in her 50s with a history of schizophrenia. On the day of admission, the patient’s family found her collapsed at home after she had taken an overdose of carbamazepine, and they called an ambulance. Upon arrival at the hospital, the patient’s bradycardia progressed to cardiac arrest. Her heartbeat resumed, but we observed drug-resistant bradycardia, so we introduced VA-ECMO. The patient was weaned from VA-ECMO on the fourth day of hospitalization and from the ventilator on the tenth day. She was discharged after 35 days. Carbamazepine is a sodium channel blocker with proarrhythmic effects. Because bradyarrhythmia during overdose is refractory to treatment, it is suggested that VA-ECMO is effective in cases of circulatory failure or cardiac arrest.