title: Extra-corporeal life support for near-fatal multi-drug intoxication: a case report.
abstract: BACKGROUND
  Severe mixed β-blocker and calcium channel blocker intoxication presents a significant risk for patient mortality. Although treatment is well-established, it sporadically fails to support the patient through massive overdoses, thus requiring non-conventional treatments. We report the use of extra-corporeal life support in a patient with refractory hemodynamic impairment due to multi-drug intoxication. Although sometimes used in clinical practice, extra-corporeal membrane oxygenation for intoxications has rarely been reported.
  
  
  METHODS
  A 36-year-old Caucasian man presented to our hospital with refractory hypotension, severe cardiac insufficiency and multi-organ failure due to mixed intoxication with atenolol, nifedipine, Lacidipine and sertraline. Together with standard treatment, we performed extra-corporeal membrane oxygenation to overcome refractory cardiogenic shock and lead the patient to achieve a full recovery.
  
  
  CONCLUSIONS
  Standard of care for β-blocker and calcium channel blocker intoxication is well-defined and condensed into protocols of treatment. Although aimed at clearing the noxious agents from the patient's system, standard measures may fail to provide adequate hemodynamic support to allow recovery. In selected cases, extra-corporeal membrane oxygenation could be considered a bridge to drug clearance while preventing multi-organ failure due to profound shock.
authors.affiliation: Dipartimento di Medicina Perioperatoria e Terapia Intensiva, Azienda Ospedaliera San Gerardo di Monza, via Pergolesi 33, Milan, Italy. roberto.rona@libero.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rona
authors.forename: Barbara
authors.initials: B
authors.lastname: Cortinovis
authors.forename: Roberto
authors.initials: R
authors.lastname: Marcolin
authors.forename: Nicolò
authors.initials: N
authors.lastname: Patroniti
authors.forename: Stefano
authors.initials: S
authors.lastname: Isgrò
authors.forename: Chiara
authors.initials: C
authors.lastname: Marelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Fumagalli