Korean J Crit Care Med.  2015 Aug;30(3):218-221. 10.4266/kjccm.2015.30.3.218.

Management of Cyanide Intoxication with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

• Park J
• Lee SY
• Choi HS
• Choi YH
• Lee YJ

• KMID: 2227653
• DOI: http://doi.org/10.4266/kjccm.2015.30.3.218

Abstract

Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with highdose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.

Keyword

brain death; cyanides; extracorporeal membrane oxygenation; organ transplantation; renal replacement therapy

MeSH Terms

Acidosis
Brain Death
Brain Stem
Coma
Cyanides
Eating
Emergency Service, Hospital
Extracorporeal Membrane Oxygenation*
Hemodynamics
Humans
Lactic Acid
Male
Middle Aged
Norepinephrine
Organ Transplantation
Poisoning
Prognosis
Reflex
Renal Replacement Therapy*
Resuscitation
Shock
Suicide
Tissue and Organ Procurement
Vital Signs
Cyanides
Lactic Acid
Norepinephrine

Figure

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  Fig. 1. Improvement in hemodynamic parameters of a cyanideintoxicated patient during management. After application of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), the patient’s mean arterial blood pressure (ABP) and urine output were gradually recovered.

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  Fig. 2. Changes in metabolic variables of the cyanide-intoxicated patient during management. Severe lactic acidosis of the patient also improved with extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT), and antidote administration (asterisk). ABE: acid base excess.

Reference

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