Background: The Impella is a percutaneous left ventricular assist device (LVAD). Current approved uses include severe left sided systolic heart failure and cardiogenic shock. There are few, if any, published cases on the use of percutaneous LVADs in poisoninduced cardiogenic shock. Acute quinine poisoning may produce a direct toxic effect on the retina in addition to tissue hypoxia, producing visual disturbances. Published case reports of hyperbaric oxygen therapy (HBOT) in quinine toxicity have reported an improvement in vision shortly following HBOT. Case report: A 45-year-old woman who intentionally ingested undisclosed amounts of citalopram and quinine presented with seizures, hypotension (systolic blood pressure 90 mmHg), and a prolonged QRS (146 msec) and QTc (650 msec). QTc and QRS prolongation were treated with multiple doses of magnesium and sodium bicarbonate, respectively. Despite these interventions, a wide complex arrhythmia persisted. Due to worsening hypotension she required maximum dose epinephrine, norepinephrine, phenylephrine, and vasopressin to maintain a mean arterial pressure (MAP) of 50. Subsequently, a percutaneous LVAD (Impella) was inserted and remained in place for 12 hours, with an increase in MAP of 10 . 20 mmHg documented within 3 hours. She was extubated approximately 12 hours following removal of the device, having been weaned off catecholamines and maintaining a MAP of 70 mmHg. Unfortunately, the patient reported seeing shadows and shades of blue. The reported vision changes were concerning for retinal toxicity secondary to quinine ingestion. After discussion with a hyperbaric specialist, she was transferred to a hyperbaric oxygen treatment center and underwent one round of HBOT. At the end of her hospital course, she reported almost complete improvement in her vision. Discussion: Percutaneous LVADs in poison-induced shock refractory to standard management and hyperbaric oxygen therapy for quinine retinal toxicity are infrequently used treatments in poisoning. This patient appeared to benefit from both treatments with no obvious adverse effects. Further studies are warranted to fully understand the risks and benefi ts of each of these interventions. However, due to limited treatment options, these procedures may be considered in cases refractory to standard treatment. Conclusion: Percutaneous LVAD may be of benefit in poisoninduced shock refractory to vasopressors. HBOT may improve visual disturbances associated with quinine-induced retinal toxicity.