Successful extracorporeal life support in a case of severe flecainide intoxication.

OBJECTIVE: To show the effectiveness of emergency extracorporeal membrane oxygenation (ECMO) in treating severe, life-threatening flecainide intoxication.

DESIGN: Case report.

SETTING: Intensive care unit in a quaternary care center.

PATIENT: A patient with electromechanical dissociation after severe flecainide acetate overdose.

INTERVENTION: ECMO.

CASE REPORT: A 30-yr-old male with a history of depression presented after a severe flecainide overdose with plasma concentrations exceeding 20 times the upper boundary of the therapeutic range. At presentation, the patient was in refractory cardiocirculatory collapse and was successfully resuscitated with ECMO. Twenty-six hours later, extracorporeal support could be discontinued and the patient made a full recovery.

CONCLUSION: In patients with severe but potentially reversible cardiac dysfunction attributable to flecainide intoxication, ECMO can maintain cardiac output and vital organ perfusion while allowing time for drug redistribution, metabolism, and clearance.