Beyond vasopressor support: VA-ECMO for refractory calcium channel blocker overdose

Calcium channel blocker (CCB) overdose is a life-threatening toxicological emergency associated with vasoplegia and multiorgan failure.We report a case of a 15-year-old male who presented with polypharmacy ingestion and refractory shock despite high-dose insulin euglycemic therapy, calcium supplementation and vasopressor support. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)was initiated 48 hours after ingestion and 40 hours after intensive care unit (ICU) admission. The patient was decannulated after 72 hours on ECMO, and discharged home on day 7 of ICU admission. This case highlights the role of VA-ECMO as a rescue intervention in severeCCB toxicity where conventional therapies fail.