Use of Veno-Arterial Extracorporeal Membrane Oxygenation in Methadone Poisoning

ABSTRACT. Poisoning with opioids, including methadone, occupies one of the leading positions in the structure of acute chemical poisonings with narcotic drugs. Often, these poisonings cause severe complications, which in some cases result in death. Traditional approaches to the treatment of these patients are in most cases limited and may be ineffective in the development of serious complications, such as refractory cardiogenic shock or acute respiratory distress syndrome; against this background, ECMO can serve not only as a method of supporting vital functions, but also as a means correction of metabolic disorders, providing optimal conditions for the body. An additional aspect that highlights the relevance of ECMO for methadone poisoning is the increasing availability of this technique in clinical practice and its potential for use in settings where other treatment methods have failed. The purpose of this work is to demonstrate the first experience of using extracorporeal membrane oxygenation in severe methadone poisoning. Results. Patient Sh., 27 years old, was found by the Emergency Medical Service (EMT) at home. At the time of examination, emergency medical services specialists examined the patient (GCS 3 points, bradypnea, hypotension, hypothermia), tracheal intubation was performed to ensure airway patency, and vasopressor support with norepinephrine was initiated. The patient was urgently taken to the intensive care unit, where effective circulatory arrest occurred, refractory to the ongoing intensive therapy, and therefore a specialized EMS ECMO team was called and VA ECMO was initiated. The patient was hospitalized in the intensive care unit of the regional vascular center (ICU RSC) of the N.V. Sklifosovsky Research Institute for Emergency Medicine, where the clinical diagnosis of “methadone poisoning” was established. Alcohol intoxication” (according to ICD-10 T40.3). Against the background of combined intensive therapy, restoration of cardiorespiratory function was noted, which made it possible to wean the VA ECMO system on the 4th day. On the 20th day (from the moment of hospitalization in the hospital), the patient in a stable somatic status was discharged from the N.V. Sklifosovsky Research Institute for Emergency Medicine. Conclusion. The observation we presented shows the effectiveness and feasibility of using VA ECMO in the development of refractory cardiogenic shock in methadone poisoning.