Davut AYDIN, Ezgi PEHLİVANLAR YAVRUCU, Eda AKSOY, Ahmet Oğuzhan KÜÇÜK, Vildan ÖZER, Mehtap PEHLİVANLAR KÜÇÜK
Türk Yoğun Bakım Dergisi - 2026;24(3):203-208
Background: Propafenone overdose is a rare but potentially fatal condition due to its potent sodium channel-blocking and cardiodepressant effects. Conventional extracorporeal elimination methods are typically ineffective owing to the drug's high protein-binding affinity and large volume of distribution. Hemoadsorption using the CytoSorb(R) device, although primarily developed for sepsis, may offer a novel therapeutic option in such intoxications. Case Presentation: We describe a 38-year-old turkish female with a history of panic disorder and paroxysmal atrial fibrillation who presented to the emergency department after a suicide attempt involving the ingestion of an estimated 40 tablets of 150 mg propafenone. She exhibited generalized tonic-clonic seizures, severe metabolic acidosis, hypotension (BP 70/50 mmHg), bradycardia (HR 55 bpm), and QRS prolongation (>150 ms). Despite high-dose intravenous sodium bicarbonate, benzodiazepines, and vasopressor support, the patient's hemodynamic instability persisted. After ICU admission and further deterioration, the patient was intubated, and PiCCO monitoring was initiated. As a last resort prior to ECMO initiation, CytoSorb(R) hemoadsorption therapy was commenced. Within one hour, her ECG normalized, vasopressors were rapidly weaned, and cardiac index improved significantly. She was extubated 21 hours later and discharged without sequelae. Conclusions: This case highlights the potential use of CytoSorb(R) hemoadsorption as an adjunctive therapy in severe propafenone poisoning, particularly in patients exhibiting refractory cardiotoxicity. Hemoadsorption may contribute to rapid clinical recovery and could potentially avert the need for more invasive interventions such as ECMO. Further clinical data are needed to validate its efficacy in this context.
