CytoSorb hemoadsorption in propafenone poisoning: a case report

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® 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® 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.