Successful rescue of aconitine poisoning with extended cardiopulmonary resuscitation combined with hemoperfusion: A case report and literature review.

Aconitine, a highly toxic alkaloid derived from Aconitum plants, exhibits a narrow therapeutic window, with a poisonous dose as low as 0.2 mg and lethal dose of 2 to 5 mg. Currently, no specific antidote exists for aconitine poisoning, which frequently triggers refractory electrical storms and cardiopulmonary arrest, culminating in high mortality. Elderly patients face particularly dire prognoses due to diminished physiological reserves. This study evaluated the efficacy of extended cardiopulmonary resuscitation (CPR) combined with hemoperfusion (HP) as a rescue strategy for aconitine-induced cardiac arrest. A 90-year-old female presented to the emergency department with a 2-hour history of dizziness, palpitations, and generalized numbness, followed by impaired consciousness after accidental ingestion of aconitine-containing medicinal wine. On admission, the patient exhibited respiratory failure, circulatory collapse, and malignant arrhythmias, including sustained ventricular tachycardia and fibrillation, which rapidly progressed to cardiac arrest. The patient was diagnosed with acute severe aconitine poisoning complicated by cardiopulmonary arrest based on a history of exposure, characteristic clinical manifestations, and electrocardiographic findings. A multidisciplinary rescue protocol was immediately implemented: endotracheal intubation and mechanical ventilation were performed, followed by continuous high-quality CPR using a Lund University Cardiopulmonary Assist System mechanical resuscitation device for a cumulative duration exceeding 200 minutes. Once CPR has established effective circulatory support, HP therapy should be initiated immediately to remove toxins from patient circulation. Combination of pharmacotherapy with antiarrhythmic agents (amiodarone and lidocaine) and vasoactive support (norepinephrine) to stabilize rhythm and perfusion. After prolonged resuscitation and multimodal detoxification, the patient's electrical storm resolved, with restoration of sinus rhythm. She regained consciousness on hospital day 3, was successfully extubated on day 4, and was discharged after 16 days without significant neurological deficits. A 3-month follow-up confirmed sustained recovery of cardiopulmonary and cerebral function. This case demonstrates that extended high-quality CPR combined with HP is a feasible and effective intervention for aconitine poisoning-related cardiac arrest, particularly when conventional antiarrhythmic and electrical therapies fail. Success depends on early recognition, persistent resuscitation, and integrated toxin removal strategies.