V-A ECMO for refractory malignant arrhythmia and cardiogenic shock following acute hydrofluoric acid burns: a case report and pathophysiology review.

backgroundHydrofluoric acid (HF) exposure causes severe systemic toxicity through fluoride ion-mediated electrolyte disturbances, leading to life-threatening cardiovascular complications. While extracorporeal membrane oxygenation (ECMO) has been reported for respiratory failure in HF poisoning, its use for refractory malignant arrhythmias and cardiogenic shock remains extremely rare. CASE PRESENTATION: A 52-year-old male worker sustained extensive HF burns (30% of total body surface area) following an industrial accident. Despite aggressive electrolyte correction and blood purification, he developed refractory ventricular arrhythmias requiring more than 37 defibrillations within 24 h and progressive cardiogenic shock requiring escalating vasopressor support (norepinephrine equivalent up to 1.3 µg/kg/min). On the advice of a multidisciplinary consultation, veno-arterial (V-A) ECMO was successfully implemented, resulting in immediate cessation of malignant arrhythmias and rapid hemodynamic stabilization. The patient was weaned from ECMO after 4 days and discharged home after complete recovery.

conclusionThis case demonstrates the life-saving potential of V-A ECMO in severe HF poisoning complicated by refractory malignant arrhythmias and cardiogenic shock. Early recognition of the need for mechanical circulatory support and timely ECMO implementation may be crucial for survival in such cases.