Rhabdomyolysis Mimicking as Oxygenator Failure in a Patient with Massive Mixed Tablet Poisoning

Introduction: Extracorporeal membrane oxygenation (ECMO) is being used worldwide for life-threatening poisoning cases when conventional treatment strategies offer limited support.This case report is about one such case of massive mixed tablet poisoning progressing to multiorgan failure even on ECMO.Case description: A 33-year-old male with massive tablet poisoning was put on VA ECMO after initial resuscitative efforts failed.It took nearly 3 days to stabilize him hemodynamically on ECMO, in spite of which he progressed to multiorgan with severe rhabdomyolysis causing myoglobinemia which mimicked oxygenator failure.Discussion: Color difference between two limbs (P1 and P3), post-membrane pO 2 levels and Delta P are the parameters practically employed by the perfusion team to monitor the function of the oxygenator.The absence of appreciable color change between P3 and P1, almost always points to a failing oxygenator, which should be confirmed by post-membrane pO 2 levels.In our case, as post-membrane pO 2 was greater than 380 mm Hg, apart from extremely elevated myoglobin levels there was no other cause which could have led to the absence of color change between P3 and P1. Conclusion:To the best of our knowledge, this is the first case report in literature about elevated myoglobin levels 4 in rhabdomyolysis mimicking oxygenator failure.