CASE REPORT Abstract Introduction: Aluminum phosphide (ALP) is one of the most common causes of poisoning. Also, it is commonly used to attempt suicide. Extracorporeal Membrane Oxygenation (ECMO) is a therapeutic method that supports the function of the heart and lungs, giving body enough time for detoxification and organ function improvement; therefore, management of the problem using ECMO is critical in these patients and increases the survival chance. Moreover, the impact of COVID-19 on the treatment course during the COVID-19 pandemic and the patients' involvement and contact with the virus is a critical issue with unknown consequences. Case presentation: The patient was an 18-year-old girl who was hospitalized due to the poisoning aluminum phosphate. The ECMO was connected to the patient during CPR. Then, the patient was transported to a specialized healthcare facility. At the time of arrival, the EF (Ejection Fraction) was less than 5%. During the course of poisoning, the patient developed ARDS, fulminant hepatitis, massive gastrointestinal and vaginal bleeding, and septicemia. The ECMO was weaned on day 5 when the EF was reported 55%. In the following, the general and pulmonary conditions of the patient exacerbated when she was suspected of having COVID-19. The necessary therapeutic measures were done and finally, the patient was discharged after 45 days. Conclusion: ECMO is a useful therapeutic procedure in ALP poisoned patients. In case of careful management, it can be used in multiple organ involvement and prolonged PCR. Considering the COVID-19 pandemic, it is very important to notice the chance of COVID-19 infection in ICU during treatment. Keywords: Aluminum Phosphide, COVID-19, Extracorporeal Membrane Oxygenation, poisoning Possible role of ECMO in multiorgan failure and prolonged CPR: Aluminum Phosphide poisoning 154 One of the most common insecticides and rodenticides used in agriculture is aluminum phosphide () [1, 2]. However, in the presence of moisture, for example in the human body after ingestion or inhalation of aluminum phosphide, this substance will result in the formation of phosphine gas [1, 2]. Therefore, this inhalation or ingestion can lead to toxicity in various organs in the body, including the heart, the kidneys, the lungs, and the liver [1-3]. The overall mortality rate reported for exposure to aluminum phosphide ranges from 30 to 77 percent [3-6]. Some of the suggested toxicity mechanisms for aluminum phosphide include suppressing oxidation in the mitochondria accompanied by significant reductions in the potential of the membrane of the mitochondria as well as the suppression of cytochrome C oxidase that results in higher levels of reactive oxygen species formation [7, 8]. Individuals exposed to aluminum phosphide will most likely suffer multisystem organ failure, followed by cardiovascular collapse, and ___________ ultimately death. On the other hand, since the dysfunction or failure of the left ventricular as well as respiratory problems caused by  poisoning can be potentially reversed during a 5 to 7-day window [2], it is recommended to employ a number of extracorporeal life support systems (ECLS), including Venoarterial Extracorporeal Membrane Oxygenation (VA ECMO), which can help maintain the functionality of the lungs and the cardiovascular system on a temporary basis for patients with severe shock. Utilizing such systems can be helpful in improving the chance of survival for these patients. In the current paper, a case is presented which may be the first published case on a patient with  poisoning who experienced cardiac arrest, while suffering from acute respiratory distress syndrome (ARDS), fulminant hepatitis, and highly suspicious for COVID-19. This patient received respiratory support as well as circulatory support using ECMO. At 10 in the morning our team received information from ______ INTRODUCTION * Correspondence to: Mahdi Daliri, MD, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Phone: +989151040818, email: m_daliri@yahoo.com MAHDI DALIRI 1 , AHMAD AMIN 2 , ZIAE TOTONCHI 2 , JAN SCHMITTO 3 , NASIM NADERI 2 MONA YADOLLAHI 2 AND SAEID HOSSEINI 1 1 Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran 2 Rajaie cardiovascular, medical and research center, Iran University of medical science. Tehran, Iran 3 Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany How to cite this article: Daliri M, Amin A, Totonchi Z, Schmitto J, Naderi N, Yadollahi, M, Hosseini S. Possible role of ECMO in multiorgan failure and prolonged CPR: Aluminum Phosphide poisoning. Asia Pac J Med Toxicol 2020; 9(4):154-158. Aluminum Phosphide poisoning and COVID19 M. Daliri et al. CASE REPORT