Usefulness of venoarterial extracorporeal membranous oxygenation for fatal cibenzoline succinate poisoning

Background: The effect of venoarterial extracorporeal membranous oxygenation (V-A ECMO), plasma exchange (PE), and direct hemoperfusion (DHP) for fatal cibenzoline succinate poisoning is unclear. We report a rare case of severe cibenzoline succinate poisoning along with cardiac arrest, wherein the patient was managed with V-A ECMO, PE, and DHP. We also measured the blood levels of cibenzoline succinate frequently. Case Presentation: A 51-year-old woman had a refractory cardiac arrest after cibenzoline succinate ingestion. We initiated V-A ECMO, PE, and DHP. Plasma exchange did not improve clinical manifestations. Her clinical condition improved during DHP, but there was no evidence about removal of drugs. On day 3, DHP and ECMO were terminated. On day 9, she was transferred to another hospital without arrhythmia recurrence. Conclusion: Venoarterial ECMO is effective in cases of cibenzoline succinate poisoning-related cardiac dysfunction or cardiac arrest. No evidence was obtained for the effects of PE and DHP.