Veno-arterial ECMO support for severe amlodipine toxicity combined with cardiogenic shock: A case report

Introduction: Management of severe circulatory collapse in the setting of amlodipine toxicity can be challenging. High doses of vasopressors and conventional therapies fail to improve hemodynamics, resulting in the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to treat severe cardiogenic shock and peripheral vasodilatation. Therapeutic plasma exchange (TPE), which helps remove plasma protein-bound toxins and significantly reduces mortality, may be a useful adjunct to invasive hemodynamic support in severe cases of amlodipine poisoning. Case summary: A 32-year-old female with a history of intentional consumption of ninety 5-mg amlodipine tablets (totaling 450 mg) was admitted to our intensive care unit (ICU) after 3 h. Her amlodipine serum concentration was 147 ng/mL. She presented with cardiogenic shock and fatal vasoplegia and received VA-ECMO and TPE. The patient was weaned off ECMO after 4 days and discharged home on Day 10 of hospitalization. Conclusion: Amlodipine toxicity can result in severe cardiac failure with circulatory collapse. We describe the case of a patient with cardiovascular collapse who successfully bridged to recovery from refractory shock secondary to severe amlodipine toxicity as a result of ECMO and TPE treatment.