Abstract

CHEON, J H; MILLER, M  and  THOMPSON, D. Beyond vasopressor support: VA-ECMO for refractory calcium channel blocker overdose. SAMJ, S. Afr. med. j. [online]. 2025, vol.115, n.10, pp.25-28. ISSN 2078-5135.  https://doi.org/10.7196/SAMJ.2025.v115i10.3256.

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 severe CCB toxicity where conventional therapies fail.

Keywords : calcium channel blocker overdose; high-dose insulin euglycaemic therapy; veno-arterial extracorporeal membrane oxygenation; vasoplegic shock; resource-limited setting.

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