Successful Management of Aluminum Phosphide-induced Refractory Cardiogenic Shock and Severe ARDS with V-AV ECMO: A Case Report

Aim and background: Aluminum phosphide (AlP) poisoning is highly lethal due to its rapid progression to refractory cardiogenic shock and severe acute respiratory distress syndrome (ARDS).Extracorporeal membrane oxygenation (ECMO) offers a potential life-saving intervention in such critical toxicological emergencies.Case description: A 40-year-old morbidly obese woman developed severe hypotension (BP: 60/40 mm Hg), tachycardia, respiratory distress, and pulmonary edema after ingesting 3 gm of AlP.Initial management with IV fluids and inotropes failed, and she was initiated on VA ECMO.After cardiac recovery but persistent hypoxia (PF ratio: 29.5), VA ECMO was converted to venoarterial to venovenous (V-AV) configuration.She was weaned off all ECMO support by day 6 and discharged on day 14.Conclusion: This case highlights ECMO's critical role in managing life-threatening toxicologic cardiopulmonary failure.Clinical significance: Venoarterial to venovenous ECMO can provide both circulatory and respiratory support in aluminum phosphide-induced shock and ARDS, offering a path to full recovery.