208 J . M . Cardenas et al .: J Extra Corpor Technol 2023 , 55 , 206 – 208
Figure 2 . Maximum Vasoactive inotropic score over time . HD : Hospital Day VIS : Vasoactive Inotropic score . thus larger cannulas through central cannulation may be needed [ 5 ]. In our patient , we estimated that a conventional peripheral cannulation would have provided an approximate maximum flow of 5 L / min ( 80 ml / kg / min , cardiac index 2.9 L / min / m 2 ), which would have been insufficient based on the degree of vasodilation and the higher flows required to obtain an adequate organ perfusion ( 7 L / min ). The increased cardiac output provided by high ECMO flows dramatically decreased the vasoactive drug requirement ( Figure 1 ) and significantly improved the end organ perfusion pressure ( Figure 2 ), correlating with a significant improvement in urine output .
Central ECMO cannulation may be helpful to facilitate adequate flows in vasodilatory shock such as dihydropyridine CCB overdose . Limited documentation exists in the use of extracorporeal life support in cases of CCB intoxication , and to our knowledge , this is the first case using central ECMO cannulation with good outcomes for severe intoxication with a dihydropyridine CCB .
Conflict of interest The authors declare no conflict of interest .
Funding The authors received no funding to complete this research .
Data availability The research data are available on request from the authors .
Ethics
Author contributions
Jose M . Cardenas : Writing- original draft . Santiago Borasino : Writing – review and editing , Supervision . Joseph Timpa : Writing – review and editing . Jeremy Hawkins : Writing – review and editing . Martha McBride : Writing – review and editing . William Rushton : Writing – review and editing . Jordan Newman : Writing – review and editing . Erika Mendoza : Writing – review and editing . Robert Sorabella : Writing – review and editing . Jonathan Byrnes : Writing – review and editing , Supervision .
References
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Ethical approval was not required .
Cite this article as : Cardenas JM , Borasino S , Timpa J , Hawkins J , McBride M , Rushton W , Newman J , Mendoza E , Sorabella R & Byrnes J Central ECMO cannulation for severe dihydropyridine calcium channel blocker overdose . J Extra Corpor Technol 2023 , 55 , 206 – 208