Use of Veno-Arterial Extracorporeal Membrane Oxygenation in Takotsubo Syndrome Due to Methadone Poisoning

Background Opioid poisoning, including methadone, occupies one of the leading positions in the structure of acute chemical poisoning by narcotic drugs and is often accompanied by severe complications, often leading to death. One of such complications is Takotsubo syndrome – an acute condition characterized, as a rule, by reversible dysfunction of the left ventricular myocardium. In the development of serious complications, standard therapeutic approaches to those patients are often insufficiently effective, which necessitates the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This method serves not only to support vital functions, but also to correct metabolic disorders, creating optimal conditions for the recovery of the body.

The aim of this work was to demonstrate clinical experience of using veno-arterial extracorporeal membrane oxygenation in severe methadone poisoning complicated by the development of Takotsubo syndrome.

Results Patient S., 21 years old, was found at home in a state of depressed consciousness and respiration. At the time of examination by the ambulance team: level of consciousness and response to stimuli were reduced (GCS 5), bradypnea, bradycardia, severe arterial hypotension, signs of aspiration of gastric contents. The time spent in a comatose state was unknown. The patient was provided with first aid, including tracheal intubation, mechanical ventilation, and vasopressor support with norepinephrine. After that, the patient was urgently hospitalized in the intensive care unit of a city clinical hospital. Despite the intensive care, progression of signs of cardiac and respiratory failure was noted. On the 4^th day, the patient was transferred to the intensive care unit of the regional vascular center (ICU RVC) of the N.V. Sklifosovsky Research Institute for Emergency Medicine. Based on the results of instrumental and laboratory tests, the following diagnosis was established: “Methadone poisoning. Toxic cardiomyopathy. Unspecified Takotsubo syndrome. Acquired long QT syndrome. Cardiac arrest with successful restoration of cardiac activity. Hospital-acquired bilateral polysegmental pneumonia. Purulent tracheobronchitis. Toxic encephalopathy”. Due to the development of refractory cardiogenic shock, the use of VA ECMO was initiated. On the 11th day, against the background of persistent stabilization of cardiorespiratory function, the patient was successfully weaned from the VA ECMO system. On the 12^th day from the moment of hospitalization, the patient was transferred to the specialized toxicology intensive care unit to continue complex therapy. On the 31^st day, the patient was discharged from the N.V. Sklifosovsky Research Institute for Emergency Medicine in a stable somatic condition.

Conclusion The presented observation demonstrates the high efficiency and feasibility of using VA ECMO in refractory cardiogenic shock caused by severe methadone poisoning with the development of Takotsubo syndrome.

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