Utilization of Extracorporeal Membrane Oxygenation for Pulmonary Toxicity Caused by Inhaled Synthetic Cannabinoid. A Harbinger of Future Complications Associated with Inhaled Cannabinoid Products

There has been a dramatic increase in medical complications related to synthetic cannabinoid (SC) use either by water pipe or vaping. The legalization of marijuana in an increasing number of states has also resulted in an increase in a number of complications related not just to marijuana, but in particular, to SC. As a result, there have been recent increased reports of acute pulmonary injury related to inhaled SC products. We describe that rarely endotracheal intubation with mechanical ventilation has been required to treat the acute respiratory distress syndrome (ARDS) and the diffuse alveolar hemorrhage (DAH) associated with the acute toxicity of SC inhalation. We describe the second reported case of successful utilization of mechanical ventilation and extracorporeal membrane oxygenation (ECMO) in order to treat acute pulmonary toxicity caused by SC inhalation by a water pipe. While the exact pathophysiology of these interesting and recent pulmonary complications is unknown, the recent increase in exposure to SC via water pipe systems and vaping suggests that there will be many more cases of patients that will require ECMO as a form of life-saving therapy.