Case report: Combination of veno-arterial extracorporeal membrane oxygenation and intra-aortic balloon pump in a young male patient with refractory cardiogenic shock due to aluminum phosphide poisoning

Background

Acute toxic myocardial damage may be accompanied by the development of cardiogenic shock (CS), the mortality from which is still unacceptably high. Since there is no specific antidote for many types of toxins, treatment of such patients includes various measures of hemodynamic and respiratory support. The paper presents a case of refractory CS due to possible aluminum phosphide (AP) poisoning.

Case summary

A 20-year-old man was admitted to the emergency department 4 days after home inhalation of AP due to complaints of nausea, vomiting, abdominal and chest pain. Over the next few hours, he rapidly developed CS, which was refractory to conservative treatment. Therefore, veno-arterial membrane oxygenation (VA-ECMO) was performed, during which hemodynamics stabilized, but later there were signs of left ventricular overload. To unload the left ventricle (LV), an intra-aortic balloon pump (IABP) was implanted, which significantly improved the patient's condition. After 6 days the patient was decannulated, and a few more days later IABP was discontinued. Subsequently, the patient was treated for sepsis due to bilateral pneumonia and acute respiratory distress syndrome and optimal medical therapy for heart failure was prescribed. The patient was discharged after 34th day of hospitalization.

Environmental Risk Assessment of Vehicle Exhaust Particles on Aquatic Organisms of Different Trophic Levels

Vehicle emission particles (VEPs) represent a significant part of air pollution in urban areas. However, the toxicity of this category of particles in different aquatic organisms is still unexplored. This work aimed to extend the understanding of the toxicity of the vehicle exhaust particles in two species of marine diatomic microalgae, the planktonic crustacean Artemia salina, and the sea urchin Strongylocentrotus intermedius. These aquatic species were applied for the first time in the risk assessment of VEPs. Our results demonstrated that the samples obtained from diesel-powered vehicles completely prevented egg fertilization of the sea urchin S. intermedius and caused pronounced membrane depolarization in the cells of both tested microalgae species at concentrations between 10 and 100 mg/L. The sample with the highest proportion of submicron particles and the highest content of polycyclic aromatic hydrocarbons (PAHs) had the highest growth rate inhibition in both microalgae species and caused high toxicity to the crustacean. The toxicity level of the other samples varied among the species. We can conclude that metal content and the difference in the concentrations of PAHs by itself did not directly reflect the toxic level of VEPs, but the combination of both a high number of submicron particles and high PAH concentrations had the highest toxic effect on all the tested species.