Introduction: Aluminum phosphide (celphos) poisoning causes severe cardiogenic shock, myocardial toxicity, and multi-organ failure, often requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for circulatory support. Delayed deterioration post-decannulation, along with the unpredictable toxic effects of celphos, complicates patient management. Case Presentation: A 25-year-old male presented with severe cardiogenic shock and ventricular tachycardia (VT) following celphos poisoning. Despite vasopressors and antiarrhythmics, he required VA-ECMO due to hemodynamic instability. After 24 hours on ECMO, he was decannulated with improved hemodynamics, though cardiac function remained compromised on 2D echocardiography. Hours post-decannulation, the patient deteriorated acutely, developing profound hypotension, recurrent VT, and acute kidney injury (AKI) with anuria, alongside reduced GCS. Despite escalation of inotropes, vasopressors, and antiarrhythmic drugs, conventional therapies failed to stabilize him. A delayed toxic effect of celphos was suspected. Re-institution of VA-ECMO was delayed by 18 hours due to logistical issues, during which the patient developed hypoxic brain injury. Once VA-ECMO was re-initiated, his hemodynamics stabilized, but neurological recovery was poor. He was discharged with a tracheostomy to a long-term care facility with significant neurological deficits. Conclusions: This case illustrates the acute deterioration that can occur after VA-ECMO decannulation in celphos poisoning, likely due to delayed toxic effects. The 18-hour delay in VA-ECMO re-initiation contributed to prolonged hypotension and severe neurological damage. Early recognition of deterioration and prompt ECMO access are critical for optimizing outcomes in such high-risk patients. VA-ECMO is crucial for managing cardiogenic shock in celphos poisoning, but delayed re-institution in cases of acute deterioration can result in poor neurological outcomes. Timely re-initiation of ECMO is essential to prevent irreversible damage.

Introduction: ECMO has become an essential tool in the management of complex cardiorespiratory failure when other interventions fail. This study provides survival and outcomes data from our center. Methods: We retrospectively reviewed cases from August 2022 to September 2024. Baseline characteristics of patients, ECMO type and indication, scoring systems, time to initiation, hospital days, ICU days, ECMO duration, successful weaning and survival rate were assessed. Results: 22 cases were identified with various indications majority being VA ECMO (68%) secondary to cardiogenic shock SCAI D->E(60%), while VV ECMO (32%) was used for severe ARDS (100%). Mean age of the patients was 47.68 ± 13.97 years with male preponderance (68%). eCPR was done in two patients out of which one patient survived to discharge, while one patient on VV ECMO required proning on ECMO. All cannulations were percutaneous (90.9%), done in cath lab except for 2 where one had morbid obesity and second had high bifurcation. Mean duration was 6.14 ± 4.29 days. Most common cause of death in VV ECMO were new onset biventricular dysfunction and bowel ischemia, while in VA ECMO it was poor neurological performance. 59% were successfully weaned and decannulated, however only 54.5% were discharged home. Scoring systems used to prognosticate were RESP, PRESERVE, and PRESET in VV, and SAVE and PREDICT -VA in VA ECMO. The most frequently observed complication was deep vein thrombosis (28.57%). When analyzed by year of cannulation, survival improved over time in both modalities. (Fig 1) Conclusions: Survival rates with ECMO for variable indications are increasing over time with cumulating experiences and techniques.

Background: Patients receiving ECMO support are vulnerable to infections, particularly by multidrug-resistant organisms (MDROs). The timing of MDRO emergence and pathogen-specific resistance patterns are critical to optimizing empiric antimicrobial strategies. Methods: We conducted a retrospective review of 81 ECMO patients with positive clinical cultures from 2019–2023. Microbiologic data were stratified by organism type, resistance phenotype, and time from ECMO cannulation (0–7 days, 8–14 days, >14 days). We also analyzed antimicrobial susceptibilities and organism-specific MDRO rates. Results: Of 159 total isolates, 50% were Gram-negative rods (GNRs), 34% Gram-positive cocci (GPCs), and 16% yeast. Klebsiella pneumoniae (n=38) and Pseudomonas aeruginosa (n=35) accounted for 46% of all isolates. Overall, 33% of patients developed MDROs; this rate was higher in Pseudomonas aeruginosa (34%) and Acinetobacter baumannii complex (57%). Among MDRO cases, 36% were isolated within 7 days of ECMO cannulation, and 40% after 14 days. After 14 days, susceptibility of Pseudomonas aeruginosa to ceftazidime-avibactam and ceftolozane-tazobactam dramatically decreased from 100% to 50% and 66.7%, respectively. Meropenem susceptibility also decreased from 86% to 57.1% after 8 days of ECMO. MDRO acquisition was associated with longer ICU stays (median 33 vs. 22 days, p=0.029), but not with increased mortality. Conclusion: MDROs emerged early and frequently in ECMO patients, particularly among Gram-negative organisms. Resistance patterns varied widely by pathogen, underscoring the need for ECMO-specific empiric strategies and early surveillance cultures to guide therapy. These data support targeted stewardship interventions in this high-risk cohort.