Background/aim: The primary purpose of this study is to report the experience on the extracorporeal membrane oxygenation (ECMO) process for patients in the critical care unit (CCU) of an Emergency Department of a tertiary hospital in Turkey, from cannulation to decannulation, including follow-up procedures. Materials and Methods: This retrospective, observational study included eight patients who received Extracorporeal Membrane Oxygenation from Jan 2018-Jan 2020. We evaluated the demographics, indications for ECMO, laboratory values, Respiratory ECMO Survival Prediction, Survival After Veno-Arterial ECMO and ECMOnet scores, the management process, and patient outcomes. Blood gas analyses from after the first hour of ECMO initiation and the re-evaluation of the patients' Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores at the 24 th hour of ECMO were recorded. Results: The mean age was 52.7 ± 14.2 years. The median duration of the ECMO run was 81 (min-max: 4-267) hours, and the mean length of CCU stay was 10.2 ± 6.7 days. Of the 8 patients studied, 5 (62.5%) had veno-arterial and 3 (37.5%) had veno-venous ECMO. Three patients were successfully weaned (37.5%). The overall survival-to-discharge rate was 25%. Carbon dioxide levels were significantly decreased 1 hour after ECMO initiation (p=0.038) as well as the need for vasopressors. Lactate levels were lower in decannulated patients. Changes in the 2 APACHE II score were more consistent with the clinical deterioration in patients than were SOFA score changes. Conclusions: In the early phase of ECMO, vital signs improve, and the need for vasopressors and carbon dioxide levels decreases. Thus, CCUs in Emergency Departments with ECMO capabilities could potentially be designed, and emergency department ECMO algorithms could be tailored for critically ill in addition to outof-hospital cardiac arrest (OHCA) patients.

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Introduction: Digoxin overdose, which may cause rhythm disturbances, such as atrioventricular blocks, can ultimately cause cardiac arrest. Extracorporeal life support may provide time until specific antidotes show an effect. Case Report: A 75-year-old male patient presented with dyspnea with a known history of congestive heart failure. His medications included digoxin, and his initial electrocardiography showed an idioventricular rhythm. His digoxin level was over the upper normal limit, and he had hyperkalemia (7.9 Meq/L). The patient collapsed during conventional therapies, including insulinglucose infusion, atropine administration, and catheterization for emergency hemodialysis, and while awaiting digoxin-specific fragment antibodies. During mechanical cardiopulmonary resuscitation, the patient was awake and had a Full Outline of Unresponsiveness score of 8, which led us to initiate veno-arterial extracorporeal membrane oxygenation. Conclusion: Extracorporeal Cardiopulmonary Resuscitation, might be a useful option for intoxicated patients when conventional therapies fail. However, more experience is needed for the increase in survival rate.

In our country and all over the world, suicide is a major public health problem, causing many premature deaths. 703,000 people died in the world in 2019, as 1 out of every 100 (1.3%) deaths was by suicide. 1 The important thing is to guarantee medical and psychiatric safety in the emergency services, which are the first gateway to health care for suicide patients.