Integrated Use of Extracorporeal Membrane Oxygenation and Molecular Adsorbent Recirculating System for Refractory Cardiotoxic Ingestion: A Single-Center Case Series
6 affiliations
- 11 Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA.
- 24 Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
- 35 Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
- 42 Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.
- 56 Division of Cardiothoracic Surgery, Department of Surgery, Emory Healthcare, Atlanta, GA.
- 63 Emory Critical Care Center, Atlanta, GA.
Abstract
BACKGROUND:. Cardiotoxic ingestions of calcium-channel blockers and beta-adrenergic antagonists are highly lethal, often causing refractory vasoplegic shock and noncardiogenic pulmonary edema. While venoarterial extracorporeal membrane oxygenation (ECMO) is a recognized rescue therapy for cardiogenic shock, the roles of venovenous ECMO and albumin dialysis—specifically the molecular adsorbent recirculating system (MARS)—as well as the effectiveness of linking patients to therapy through a coordinated referral process remain underexplored. CASE SUMMARY:. We describe five consecutive patients with severe cardiotoxic ingestions managed via a regionally triggered transfer pathway. Patients presented with profound hypotension and respiratory failure despite standard therapies. All five patients received MARS for drug clearance and vasoplegia management; two required venovenous ECMO for refractory hypoxemia. One patient died due to profound myocardial poisoning; four survived to discharge. Complications included continuous renal replacement therapy filter clotting and catheter-associated thrombosis. CONCLUSIONS:. A coordinated regional protocol enabling early access to ECMO and MARS is feasible in massive cardiotoxic ingestions.
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BibTeX
@article{toriehrhardt2026integrated,
title = {{Integrated Use of Extracorporeal Membrane Oxygenation and Molecular Adsorbent Recirculating System for Refractory Cardiotoxic Ingestion: A Single-Center Case Series}},
author = {Tori Ehrhardt, MD and C. Christopher Zalesky, MD, MSc and Aaron Shepherd, MD and Joshua L. Chan, MD and Ram M. Subramanian, MD and Craig S. Jabaley, MD, FCCM and Melissa Morris, MSN, ACAGNP-BC and Laura Franco, MSN, APRN and Casey Miller, MSN, ACAGNP-BC and Terrance Oster, MSN, ACAGNP-BC and Katherine L. Nugent, MD and Christina Creel-Bulos, MD and Emily Kiernan, DO and Sagar B. Dave, DO},
journal = {Critical Care Explorations},
year = {2026},
month = oct,
doi = {10.1097/cce.0000000000001499},
url = {https://doi.org/10.1097/cce.0000000000001499},
note = {CC BY},
}
RIS
TY - JOUR
TI - Integrated Use of Extracorporeal Membrane Oxygenation and Molecular Adsorbent Recirculating System for Refractory Cardiotoxic Ingestion: A Single-Center Case Series
AU - Tori Ehrhardt, MD
AU - C. Christopher Zalesky, MD, MSc
AU - Aaron Shepherd, MD
AU - Joshua L. Chan, MD
AU - Ram M. Subramanian, MD
AU - Craig S. Jabaley, MD, FCCM
AU - Melissa Morris, MSN, ACAGNP-BC
AU - Laura Franco, MSN, APRN
AU - Casey Miller, MSN, ACAGNP-BC
AU - Terrance Oster, MSN, ACAGNP-BC
AU - Katherine L. Nugent, MD
AU - Christina Creel-Bulos, MD
AU - Emily Kiernan, DO
AU - Sagar B. Dave, DO
PY - 2026
DA - 2026/10/29
JO - Critical Care Explorations
DO - 10.1097/cce.0000000000001499
UR - https://doi.org/10.1097/cce.0000000000001499
AB - BACKGROUND:. Cardiotoxic ingestions of calcium-channel blockers and beta-adrenergic antagonists are highly lethal, often causing refractory vasoplegic shock and noncardiogenic pulmonary edema. While venoarterial extracorporeal membrane oxygenation (ECMO) is a recognized rescue therapy for cardiogenic shock, the roles of venovenous ECMO and albumin dialysis—specifically the molecular adsorbent recirculating system (MARS)—as well as the effectiveness of linking patients to therapy through a coordinated referral process remain underexplored. CASE SUMMARY:. We describe five consecutive patients with severe cardiotoxic ingestions managed via a regionally triggered transfer pathway. Patients presented with profound hypotension and respiratory failure despite standard therapies. All five patients received MARS for drug clearance and vasoplegia management; two required venovenous ECMO for refractory hypoxemia. One patient died due to profound myocardial poisoning; four survived to discharge. Complications included continuous renal replacement therapy filter clotting and catheter-associated thrombosis. CONCLUSIONS:. A coordinated regional protocol enabling early access to ECMO and MARS is feasible in massive cardiotoxic ingestions.
SN - 2639-8028
ER -