Unexpected survival after deliberate phosphine gas poisoning: An Australian experience of extracorporeal membrane oxygenation rescue in this setting

Anaesth Intensive Care. 2022 May;50(3):250-254. doi: 10.1177/0310057X211047603. Epub 2021 Dec 6.

Abstract

Phosphine poisoning is responsible for hundreds of thousands of deaths per year in countries where access to this pesticide is unrestricted. Metal phosphides release phosphine gas on contact with moisture, and ingestion of these tablets most often results in death despite intensive support. A 36-year-old woman presented to a regional hospital after ingesting multiple aluminium phosphide pesticide tablets and rapidly developed severe cardiogenic shock. In this case, serendipitous access to an untested Extracorporeal Membrane Oxygenation (ECMO) service of a regional hospital effected a successful rescue and prevented the predicted death. We discuss the toxicology, management and the evidence for and against using ECMO in this acute poisoning.

Keywords: Aluminium phosphide; cardiogenic; drug overdose; extracorporeal membrane oxygenation; phosphine; poisons; shock.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Australia
  • Extracorporeal Membrane Oxygenation* / methods
  • Female
  • Gas Poisoning*
  • Humans
  • Pesticides*
  • Phosphines
  • Shock, Cardiogenic

Substances

  • Pesticides
  • Phosphines
  • phosphine