From the emergency department to veno-venous ECMO- a case of refractory hypoxia

A known rare side effect of naloxone administration is non-cardiac pulmonary edema. There have been multiple proposed mechanisms for this, the most accepted one being a catecholamine surge causing physiologic changes favoring the development of pulmonary edema. The literature is sparse on this clinical entity, mostly consisting of case reports and a case series. Here we present a case of a young male who presents with refractory hypoxia and shock requiring emergent Extracorporeal Membrane Oxygenation (ECMO) consultation and cannulation for veno-venous ECMO(VV-ECMO) from the emergency department. The patient responded well and was decannulated and extubated within 50 hours and ultimately discharged on hospital day 6. This would be a rare publication of VV-ECMO being used emergently for hypoxic respiratory failure secondary to naloxone-induced pulmonary edema compounded by subsequent aspiration in the Emergency Department.