The Role of Extracorporeal Membrane Oxygenation in Cyanide Poisoning

Cyanide affects organs through mitochondrial degradation. Recently, extracorporeal membrane oxygenation (ECMO) has been used to preserve vital organ functions in poisonings and has saved antidote therapy time. We presented a case of cyanide poisoning who underwent ECMO and had brain death. A 28-year-old patient was brought in with oral cyanide intake 30 minutes ago. He was hypotensive, tachycardic, and in a coma. There was lactic acidosis. Global hypokinesia in the heart was observed on echocardiography. Venoarterial ECMO was planned to maintain perfusion. In preparation for ECMO, ventricular fibrillation developed, defibrillation was performed, and the rhythm reverted to atrial fibrillation. Before ECMO administration, hydroxocobalamin was given at the 4th hour of cyanide intake. Blood pressure increased after the antidote. Although blood pressure improved, venoarterial ECMO was performed at the 4th hour, considering that perfusion might deteriorate again due to high lactate levels and malignant arrhythmia. Brain death was diagnosed on the second day. The transplant was cancelled because the transplant committee was concerned about complications with cyanide. The patient died on the third day. It is known that cyanide disrupts intracellular metabolism and causes brain damage independent of perfusion. Therefore, ECMO failed to prevent permanent brain damage in cyanide poisoning.