Beyond vasopressor support: VA-ECMO for refractory calcium channel blocker overdose

Authors

  • J-H Cheon Division of Critical Care, Department of Anaesthesia and Post-Operative Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa https://orcid.org/0009-0007-0976-4436
  • M Miller Division of Critical Care, Department of Anaesthesia and Post-Operative Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa https://orcid.org/0000-0001-6137-7723
  • D Thomson Division of Critical Care, Department of Anaesthesia and Post-Operative Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa https://orcid.org/0000-0003-2433-3611

DOI:

https://doi.org/10.7196/SAMJ.2025.v115i10.3256

Keywords:

Calcium Channel Blocker Overdose, ECMO, Critical Care

Abstract

Calcium channel blocker (CCB) overdose is a life-threatening toxicological emergency associated with vasoplegia and multiorgan failure.We report a case of a 15-year-old male who presented with polypharmacy ingestion and refractory shock despite high-dose insulin euglycemic therapy, calcium supplementation and vasopressor support. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)was initiated 48 hours after ingestion and 40 hours after intensive care unit (ICU) admission. The patient was decannulated after 72 hours on ECMO, and discharged home on day 7 of ICU admission. This case highlights the role of VA-ECMO as a rescue intervention in severeCCB toxicity where conventional therapies fail.

Author Biographies

  • M Miller, Division of Critical Care, Department of Anaesthesia and Post-Operative Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
    Malcolm Miller Consultant Anaesthetist and Critical Care Subspecialist MBChB , FCA (SA), Cert Critical Care
  • D Thomson, Division of Critical Care, Department of Anaesthesia and Post-Operative Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
    Consultant Surgeon Transplant Unit and Critical Care Subspecialist MBChB (UKZN), FCS (SA), Cert Critical Care

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Published

2025-11-04

Issue

SAMJ Vol. 115 no. 10

Section

In Practice

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Copyright (c) 2025 J-H Cheon, M Miller, D Thomson

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How to Cite

1.
Cheon J-H, Miller M, Thomson D. Beyond vasopressor support: VA-ECMO for refractory calcium channel blocker overdose. S Afr Med J [Internet]. 2025 Nov. 4 [cited 2025 Nov. 13];115(10):e3256. Available from: https://samajournals.co.za/index.php/samj/article/view/3256