Blood pressure increased after the antidote. Before ECMO administration, hydroxocobalamin was given at the 4th hour of cyanide intake. In preparation for ECMO, ventricular fibrillation developed, defibrillation was performed, and the rhythm reverted to atrial fibrillation. Venoarterial ECMO was planned to maintain perfusion.
Global hypokinesia in the heart was observed on echocardiography. He was hypotensive, tachycardic, and in a coma. A 28-year-old patient was brought in with oral cyanide intake 30 minutes ago. We presented a case of cyanide poisoning who underwent ECMO and had brain death. Recently, extracorporeal membrane oxygenation (ECMO) has been used to preserve vital organ functions in poisonings and has saved antidote therapy time. With an understanding of these concepts, you too, will be able to treat that secret agent who is trying to kill himself (or herself) before they reveal the secret plans.Cyanide affects organs through mitochondrial degradation. This is complicated by the lack of a readily available assay and the variability of available antidotes.
The management of cyanide poisoning requires firstly the identification of patients who may be at risk of cyanide poisoning and the selection of antidotes. Hydroxocobalamin is widely used in Europe but only has limited availability in North America and Australia. In North America amyl nitrate pearls for inhalation can also used be used. In Australia dicobalt edetate IV, sodium nitrite IV and sodium thiosulfate are available. The availability of antidotes to cyanide poisoning varies around the world. Another source of cyanide includes the combustion of wool, silk, synthetic rubber and polyurethane. Deliberate contamination of medications and food has occurred recently. Suicides are the commonest cause of cyanide poisoning. Industries that use cyanide include metal extraction and refining, electroplating, photography and fumigation. It is important to know the unique mechanism of action of this poison as delay in treatment can have disastrous consequences to the patient. It is used in many chemical compounds including medications and can be found endogenously in plant and bacteria. Its toxicity was soon discovered by Scheele who, upon breaking the flask of his newly found fluid, was killed by the resulting vapours.Ĭyanide is a rapidly toxic agent that is found in liquid and gaseous form. Hydrogen cyanide was not isolated in a pure form until 1786 when Scheele extracted it from the dye Prussian blue.
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